Does Difficult Mask Ventilation Predict Obstructive Sleep Apnea? A Prospective Pilot Study to Identify the Prevalence of OSA in Patients with Difficult Mask Ventilation Under General Anesthesia

Background: Given the pathogenesis of obstructive sleep apnea (OSA), anesthesiologists may be in a unique position to rapidly identify patients who are at risk for undiagnosed OSA in the perioperative period. Identification is the first step in prompt diagnosis and potential prevention of OSA related comorbidities. Patients who exhibit unanticipated difficult mask ventilation (DMV) during induction of general anesthesia may be at risk of having undiagnosed OSA. Objective: To determine the association of OSA in patients with difficult mask ventilation under general anesthesia. Methods: Ten patients were identified over a 2-year period at the time of anesthetic induction as being difficult to mask ventilate and were then enrolled in this prospective pilot study. After enrollment and informed consent, the patients were referred to the sleep study center for full overnight polysomnography to evaluate for the presence and severity of OSA. Results: Of our cohort, 9/10 patients exhibited polysomnographic evidence of OSA, while the last subject tested positive for sleep disordered breathing. Eighty percent (8/10) of subjects espoused snoring, but only 10% (1/10) reported witnessed apneas. Average DMV was 2.5, and higher grades of DMV were associated with more severe OSA. Conclusion: In this study, difficult mask ventilation was predictive of undiagnosed OSA. Anesthesiologists may be in a unique position to identify patients at risk for OSA and prevention of related comorbidities.