British Journal of Anaesthesia, Vol 80, Issue 5 606-611, Copyright © 1998 by The Board of Management and Trustees of the British Journal of Anaesthesia
A. S. Hiremath, D. R. Hillman, A. L. James, W. J. Noffsinger, P. R. Platt and S. L. Singer
The upper airway abnormalities predisposing to difficult tracheal
intubation may also predispose to obstructive sleep apnoea (OSA). The
potential association is important as both conditions increase
perioperative risk and patients with a trachea that is difficult to
intubate may need assessment for OSA. We determined if patients with
difficult intubation are at greater risk of OSA and, if so, whether or not
they have characteristic clinical or radiographic upper airway changes. We
studied 15 patients in whom the trachea was difficult to intubate and 15
control patients. Each was evaluated clinically (Mallampati score,
thyromental distance, neck circumference, head extension),
polysomnographically (apnoea-hypoponea index (AHI)) and radiographically
(lateral cephalometry). AHI was greater in the difficult intubation group
(mean 28.4 (SD 31.7)) compared with controls (5.9 (8.9)) (P < 0.02);
eight of 15 patients in the difficult intubation group and two of 15 in the
control group had an AHI > 10 (P < 0.03). Difficult intubation, but
not OSA, was associated (P < 0.05) with a smaller thyromental distance
and mandibular length, and greater soft palate length. Both difficult
intubation and OSA were associated (P < 0.05) with a greater Mallampati
score, anterior mandibular depth, and smaller mandibular and cervical
angles. OSA, but not difficult intubation, was associated (P < 0.05)
with increased neck circumference, tongue area and craniocervical angle,
and decreased head extension, mandibular ramus length and atlantooccipital
distance. We conclude that difficult intubation and OSA are related
significantly. They share anatomical features which act to reduce the
skeletal confines of the tongue. Patients with OSA may compensate, when
awake, by increasing craniocervical angulation, which increases the space
between the mandible and cervical spine and elongates the tongue and soft
tissues of the neck.
CLINICAL INVESTIGATIONS
Relationship between difficult tracheal intubation and obstructive sleep apnoea
Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia; Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia; Department of Dentistry, Princess Margaret Hospital, Perth, Western Australia
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