Obstructive sleep apnea is a risk factor for difficult endotracheal intubation.

Le résumé fourni par la source

O sleep apnea (OSA) is a common disorder with an incidence ranging from 2% to 4% of the adult population. The signs, symptoms and consequences of OSA are a direct result of the derangements caused by the repetitive collapse of the upper airways: sleep fragmentation, hypoxemia, hypercapnia, marked variations in intrathoracic pressures, and increased sympathetic activity. Undiagnosed OSA is a well known problem in adult surgical patients.1 Although there are some studies suggesting an association between the OSA, its severity and the occurrence of difficult intubation, this issue remains controversial. Thus we designed a retrospective case-control study to assess the incidence of difficult intubation in OSA patients and to assess the correlation between difficult intubation and the severity of OSA. After obtaining study approval of the Hospital’s institutional review board, we reviewed the perioperative records of 145 patients with a polysomnography-confirmed diagnosis of OSA who were submitted to sleep apnea surgery between july 2008 and December 2009. OSA severity was measured by the apnea-hypopnea index (AHI), defined as the number of apnea and hypopnea events per hour of sleep, and the lowest oxygen saturation associated with an abnormal respiratory event during sleep (LSAT). As control group we reviewed all perioperative records of the patients undergoing ear, nose, and throat (ENT) surgery in the same period. The control patients were matched for gender and age (±10). Data are presented as mean±SD or percentage when needed. P<0.05 was defined as statistically significant. Student’s T Tests and χ2 analysis were used to compare the two groups. Difficult intubation was defined according to the SIAARTI recommendations for difficult airway management.2 Among 1408 patients included, 145 and 1263 patients were in the OSA and control groups, respectively. Sleep apnea surgery included bilateral turbinectomy, tonsillectomy, septoplasty, uvulopalatopharyngoplasty and maxillo-mandibular advancement. These procedures were often combined. Difficult intubation occurred more often in OSA patients (24%) compared with controls (3%). In OSA patients in whom difficult intubation was found, Body Mass Index (BMI), Apnea-Hypopnea Index AHI and LSAT were not different from values obtained in OSA patients who underwent easy intubation (Table I). This study demonstrates that the occurrence of difficult intubation in OSA patients is higher than in control patients. No relationship was found between the LSAT, the AHI which was one of the most commonly used indexes to describe the severity of OSA and the occurrence of difficult intubation. The relationship between difficult intubation and OSA has been speculated upon for a long time, but few reports have shown an association between difficult intubation and OSA.3, 4 Recently this assumption Obstructive sleep apnea is a risk factor for difficult endotracheal intubation

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