1.Predictors of difficulty in intubation in patients with obstructive sleep apnoea
Cybil Mei Zhi Wang ; Kenny Peter Pang ; Tan Soo Guan ; Kathleen Ann Pang ; Edward Benjamin Pang ; Tan Yuk Ngi Cherilynn ; Yiong Huak Chan ; Brian W. Rotenberg
The Medical Journal of Malaysia 2019;74(2):133-137
Objective: To evaluate predictors of difficult intubation in
patients with obstructive sleep apnoea (OSA).
Methodology: Prospective series of 405 OSA patients (350
males/55 females) who had upper airway surgery.
Procedures included functional endoscopic sinus surgery,
septoplasty, turbinate reduction, palate/tonsil surgery,
and/or tongue base surgery. Intubation difficulty (ID) was
assessed using Mallampati grade, Laryngoscopic grade
(Cormack and Lehane), and clinical parameters including
BMI, neck circumference, thyromental distance, jaw
adequacy, neck movements and glidescope grading.
Results: Mean age was 41.6 years old; mean BMI 26.6; mean
neck circumference 44.5cm; mean Apnea Hypopnea Index
(AHI) was 25.0; and mean LSAT 82%. The various laryngeal
grades (based on Cormack and Lehane), grade 1 - 53
patients (12.9%), grade 2A - 127 patients (31.0%), grade 2B -
125 patients (30.5%), grade 3 - 93 patients (22.7%) and grade
4 - seven patients (1.7%); hence, 24.4% had difficulties in
intubation. Parameters that adversely affected intubation
were, age of the patient, opening of mouth, retrognathia,
overbite, overjet, limited neck extension, thyromental
distance, Mallampati grade, and macroglossia (p<0.001).
Body mass index (BMI) (p=0.087), neck circumference
(p=0.645), neck aches (p=0.728), jaw aches (p=0.417), tonsil
size (p=0.048), and AHI (p=0.047) had poor correlation with
intubation. BMI-adjusted for Asians and Caucasians,
showed that Asians were more likely to have difficulties in
intubation (adjusted OR = 4.6 (95%Confidence Interval: 1.05
to 20.06) (p=0.043), compared to the Caucasian group.
2.SLEEP-GOAL: A multicenter success criteria outcome study on 302 obstructive sleep apnoea (OSA) patients
Kenny P. Pang ; Peter M Baptista J ; Ewa Olszewska ; Itzhak Braverman ; Marina Carrasco Llatas ; Srivinas Kishore ; Sudipta Chandra ; Hyung Chae Yang ; Yiong Huak Chan ; Kathleen Ann Pang ; Edward Benjamin Pang ; Brian Rotenberg
The Medical Journal of Malaysia 2020;75(2):117-123
Objective: To demonstrate SLEEP-GOAL as a more holistic
and comprehensive success criterion for Obstructive Sleep
Apnoea (OSA) treatment.
Methods: A prospective 7-country clinical trial of 302 OSA
patients, who met the selection criteria, and underwent
nose, palate and/or tongue surgery. Pre- and post-operative
data were recorded and analysed based on both the Sher
criteria (apnoea hypopnea index, AHI reduction 50% and
<20) and the SLEEP-GOAL.
Results: There were 229 males and 73 females, mean age of
42.4±17.3 years, mean BMI 27.9±4.2. The mean VAS score
improved from 7.7±1.4 to 2.5±1.7 (p<0.05), mean Epworth
score (ESS) improved from 12.2±4.6 to 4.9±2.8 (p<0.05),
mean body mass index (BMI) decreased from 27.9±4.2 to
26.1±3.7 (p>0.05), gross weight decreased from 81.9±14.3kg
to 76.6±13.3kg. The mean AHI decreased 33.4±18.9 to
14.6±11.0 (p<0.05), mean lowest oxygen saturation (LSAT)
improved 79.4±9.2% to 86.9±5.9% (p<0.05), and mean
duration of oxygen <90% decreased from 32.6±8.9 minutes
to 7.3±2.1 minutes (p<0.05). The overall success rate (302
patients) based on the Sher criteria was 66.2%. Crosstabulation of respective major/minor criteria fulfilment,
based on fulfilment of two major and two minor or better, the
success rate (based on SLEEP-GOAL) was 69.8%. Based
solely on the Sher criteria, 63 patients who had significant
blood pressure reduction, 29 patients who had BMI
reduction and 66 patients who had clinically significant
decrease in duration of oxygen <90% would have been
misclassified as “failures”.
Conclusion: AHI as a single parameter is unreliable.
Assessing true success outcomes of OSA treatment,
requires comprehensive and holistic parameters, reflecting
true end-organ injury/function; the SLEEP-GOAL meets
these requirements