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Nico De Vries - One of the best experts on this subject based on the ideXlab platform.
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sleep endoscopy versus modified Mallampati Score in sleep apnea and snoring
Laryngoscope, 2005Co-Authors: Cindy Den Herder, Harm Van Tinteren, Nico De VriesAbstract:Objectives/Hypothesis: The aim of this study is to quantify the correlation between a large tongue classified by the modified Mallampati Score (MMS) and obstruction at the tongue base observed during sleep endoscopy in patients with socially unacceptable snoring (SUS) and obstructive sleep apnea syndrome (OSAS). Study Design: Prospective. Methods: One hundred twenty-seven patients with obstructive sleep apnea and SUS underwent sleep endoscopy. Patients were classified into four specific groups according to their MMS. After intravenous administration of midazolam, obstructive events in the upper airway were classified. The level of obstruction was expressed as palatal (2), palatal and to a lesser degree base of the tongue/laryngeal level (23), tongue base/laryngeal level and to a lesser degree palatal (32), and tongue base/laryngeal level (3). The degree of correlation between the level of obstruction and the MMS was analyzed by means of Spearman's rank-order correlation. Results: No linear association between the level of obstruction and MMS could be found. A large tongue (MMS 3 or 4) does not predict obstruction at the base of the tongue. Patients classified as MMS 1 or 2 did not frequently show obstruction at the base of the tongue (9 of 38, 23,6%). The majority of the population showed retropalatal obstruction. A large tongue (MMS 3 or 4) was often accompanied by retropalatal obstruction, 76% of the cases (64 of 89). Conclusions: No positive correlation exists between a large tongue and obstruction at tongue base level. In both groups, retropalatal obstruction occurred more often than retrolingual obstruction. Sleep endoscopy provides qualitative insight into important changes during sleep in patients with SUS and OSAS. In addition, anatomic aberrations are clearly visualized in a dynamic setting. Classification of the size of the tongue, as assessed by the MMS, may be of great importance as well.
Serge C Thal - One of the best experts on this subject based on the ideXlab platform.
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combination of stop bang Score with Mallampati Score fails to improve specificity in the prediction of sleep disordered breathing
Minerva Anestesiologica, 2016Co-Authors: F Dette, J Graf, Werner Cassel, Carla Lloydjones, Stefan Boehm, Martin Zoremba, Patrick Schramm, Gunther Pestel, Serge C ThalAbstract:BACKGROUND: Sleep-disordered breathing (SDB) is closely associated with perioperative complications. STOP-Bang Score was validated for preoperative screening of SDB. However, STOP-Bang Score lacks adequately high specificity. We aimed to improve it by combining it with the Mallampati Score. METHODS: The study included 347 patients, in which we assessed both STOP-Bang and Mallampati Scores. Overnight oxygen saturation was measured to calculate ODI4%. We calculated the sensitivity and specificity for AHI and ODI4% of both Scores separately and in combination. RESULTS: We found that STOP-Bang Score ≥3 was present in 71%, ODI≥5/h (AHI ≥5/h) in 42.6% (39.3%) and ODI≥15/h (AHI ≥15/h) in 13.5% (17.8%). For ODI4%≥5/h (AHI ≥5/h) we observed in men a response rate for sensitivity and specificity of STOP-Bang of 94.5% and 17.1% (90.9% and 12.5%) and in women 66% and 51% (57.8% and 46.9%). For ODI4%≥15/h (AHI≥15/h) it was 92% and 12% (84.6% and 10.3%) and 93% and 49% (75% and 49.2%). For ODI4%≥5 (AHI≥5) sensitivity and specificity of Mallampati Score were in men 38.4% and 78.6% (27.3% and 68.2%) and in women 25% and 82.7% (21.9% and 81.3%), for ODI≥15 (AHI ≥15/h) 38.5% and 71.8% (26.9% and 69.2%) and 33.3% and 81.4% (17.9% and 79.6%). In combination, for ODI4%≥15/h, we found sensitivity in men to be 92.3% and in women 93.3%, specificity 10.3% and 41.4%. CONCLUSIONS: STOP-Bang Score combined with Mallampati Score fails to increase specificity. Low specificity should be considered when using both Scores for preoperative screening of SDB.
Thomas J Nuckton - One of the best experts on this subject based on the ideXlab platform.
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physical examination Mallampati Score as an independent predictor of obstructive sleep apnea
Sleep, 2006Co-Authors: Thomas J Nuckton, David V Glidden, Warren S Browner, David M ClamanAbstract:STUDY OBJECTIVE: To assess the clinical usefulness of the Mallampati Score in patients with obstructive sleep apnea. Mallampati scoring of the orophyarynx is a simple noninvasive method used to assess the difficulty of endotracheal intubation, but its clinical usefulness has not been validated in patients with sleep-disordered breathing. DESIGN: Prospective multivariate assessment of a predictor variable. SETTING: The UCSF Sleep Disorders Center. PATIENTS OR PARTICIPANTS: One hundred thirty-seven adult patients who were evaluated for possible obstructive sleep apnea. INTERVENTIONS: Prospective determination of the Mallampati Score, assessment of other variables for multivariate analysis, and subsequent overnight polysomnography. MEASUREMENTS AND RESULTS: The Mallampati Score was an independent predictor of both the presence and severity of obstructive sleep apnea. On average, for every 1-point increase in the Mallampati Score, the odds of having obstructive sleep apnea (apnea-hypopnea index> or = 5) increased more than 2-fold (odds ratio [per 1-point increase] = 2.5; 95% confidence interval: 1.2-5.0; p = .01), and the apnea-hypopnea index increased by more than 5 events per hour (coefficient = 5.2; 95% confidence interval: 0.2-10; p = .04). These results were independent of more than 30 variables that reflected airway anatomy, body habitus, symptoms, and medical history. CONCLUSION: Our results indicate that Mallampati scoring is a useful part of the physical examination of patients prior to polysomnography. The independent association between Mallampati Score and presence and severity of obstructive sleep apnea suggests that this scoring system will have practical value in clinical settings and prospective studies of sleep-disordered breathing.
Daniel Rodenstein - One of the best experts on this subject based on the ideXlab platform.
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high Mallampati Score and nasal obstruction are associated risk factors for obstructive sleep apnoea
European Respiratory Journal, 2003Co-Authors: Giuseppe Liistro, Philippe Rombaux, Catharina Belge, Myriam Dury, Genevieve Aubert, Daniel RodensteinAbstract:Induced nasal obstruction can cause obstructive apnoeas in healthy subjects during sleep, but the relationship between nasal resistance measured during wakefulness and obstructive sleep apnoea syndrome (OSAS) is weak. It was postulated that if the subjects could not breathe through the nose, the oral airway must be used, but if this airway is narrowed as well, then it could precipitate sleep-disordered breathing (SDB). Nasal patency, Mallampati Score (MS), neck circumference and body mass index were measured in 202 subjects referred to the authors' hospital to undergo a full-night polysomnography for suspicion of SDB. A significant correlation was found between the MS and apnoea/hypopnoea index measured during sleep. However, the relationship between these parameters was only significant in patients with nasal obstruction. The relative risk of having OSAS with a MS of III or IV was 1.95 for the whole group and 2.45 in patients with nasal obstruction. In conclusion, a high Mallampati Score represents a predisposing factor for obstructive sleep apnoea syndrome, especially if it is associated with nasal obstruction. These patients merit special attention from both the sleep physician and the anaesthetist.
R. Gottschall - One of the best experts on this subject based on the ideXlab platform.
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Prognostische Wertigkeit von Screeningtests für die erschwerte Mikrolaryngoskopie
Hno, 2002Co-Authors: A. Müller, L. Verges, R. GottschallAbstract:Hintergrund und Fragestellung. Zur Vorhersage der schwierigen endotrachealen Intubation sind zahlreiche Screeningverfahren, wie der Test nach Patil oder der Mallampati-Score bekannt. Die Inzidenz der erschwerten Mikrolaryngoskopie und die prognostische Wertigkeit von Screeningtests fur deren Vorhersage wurde bisher nicht untersucht.
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Prognostische Wertigkeit von Screeningtests für die erschwerte Mikrolaryngoskopie
HNO, 2002Co-Authors: A. Müller, L. Verges, R. GottschallAbstract:Hintergrund und Fragestellung. Zur Vorhersage der schwierigen endotrachealen Intubation sind zahlreiche Screeningverfahren, wie der Test nach Patil oder der Mallampati-Score bekannt. Die Inzidenz der erschwerten Mikrolaryngoskopie und die prognostische Wertigkeit von Screeningtests für deren Vorhersage wurde bisher nicht untersucht. Patienten und Methoden. In die prospektive Studie wurden 81 Mikrolaryngoskopien eingeschlossen. Mit einem speziellen Laryngometer wurde der erzielte Überblick über die Glottis während supraglottischer Jetventilation bewertet. Ergebnisse. Die Inzidenz der erschwerten Mikrolaryngoskopie betrug 4,9%. Alle betrachteten Scores erreichten nicht die erhoffte Treffsicherheit. Die vom HNO-Arzt präoperativ durchgeführte indirekte Laryngoskopie (mit Phonation) erzielte mit einem “positiven Vorhersagewert” (PVW) von 50% das beste Ergebnis. Schlussfolgerung. Die unvollständige Spiegelbarkeit des Larynx kann als warnender Hinweis für eine erschwerte Mikrolaryngoskopie gelten. Summations-Scores wie der von Arné vorgeschlagene multivariate Risikoindex oder der Einsatz von Checklisten (Benumof) lassen zukünftig eine bessere Prädiktion der erschwerten Laryngoskopie erwarten. Background. Several screening methods for the prediction of a difficult endotracheal intubation such as the test by Patil or the Mallampati-Score have been described. The incidence of difficult microlaryngoscopic procedures and the prognostic value of those screening tests for their prediction has not been investigated. Patients and methods. We examined 81 patients with mainly benign conditions of the larynx in a prospective study to evaluate the maximal overview of the glottis gained during microlaryngoscopy under supraglottic jetventilation. We used a specially designed ruler to measure the length of the invisible portion of the glottis. Results. The incidence of a difficult microlaryngoscopy was 4.9%. All employed screening Scores did not reach a satisfactory positive predictive value (PPV). The routine indirect laryngoscopy with phonation had the highest PPV (50%) of all tests. Conclusion. Therefore an impossible indirect laryngoscopy can be regarded as a warning sign for a difficult microlaryngoscopic procedure. Summation-Scores like the Arné Multivariate Risk Index or the use of check lists (Benumof) may improve the predictive value of preoperative screening.