Department of Anesthesia & Perioperative Medicine, University Hospital, Victoria Hospital and St. Joseph Hospital, London Health Sciences Centre and St. Joseph Health Care, Western University, London, ON, Canada.
Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
PLoS One. 2018 Oct 4;13(10):e0204904. doi: 10.1371/journal.pone.0204904. eCollection 2018.
Difficult airway management and obstructive sleep apnea may contribute to increased risk of perioperative morbidity and mortality. The objective of this systematic review and meta-analysis (SRMA) is to evaluate the evidence of a difficult airway being associated with obstructive sleep apnea (OSA) patients undergoing surgery.
The standard databases were searched from 1946 to April 2017 to identify the eligible articles. The studies which included adult surgical patients with either suspected or diagnosed obstructive sleep apnea must report at least one difficult airway event [either difficult intubation (DI), difficult mask ventilation (DMV), failed supraglottic airway insertion or difficult surgical airway] in sleep apnea and non-sleep apnea patients were included.
Overall, DI was 3.46-fold higher in the sleep apnea vs non-sleep apnea patients (OSA vs. non-OSA: 13.5% vs 2.5%; OR 3.46; 95% CI: 2.32-5.16, p <0.00001). DMV was 3.39-fold higher in the sleep apnea vs non-sleep apnea patients (OSA vs. non-OSA: 4.4% vs 1.1%; OR 3.39; 95% CI: 2.74-4.18, p <0.00001). Combined DI and DMV was 4.12-fold higher in the OSA vs. non-OSA patients (OSA vs. non-OSA: 1.1% vs 0.3%; OR 4.12; 95% CI: 2.93-5.79, p <0.00001). There was no significant difference in the supraglottic airway failure rates in the sleep apnea vs non-sleep apnea patients (OR: 1.34; 95% CI: 0.70-2.59; p = 0.38). Meta-regression to adjust for various subgroups and baseline confounding factors did not impact the final inference of our results.
This SRMA found that patients with obstructive sleep apnea had a three to four-fold higher risk of difficult intubation or mask ventilation or both, when compared to non-sleep apnea patients.
困难气道管理和阻塞性睡眠呼吸暂停可能会增加围手术期发病率和死亡率。本系统评价和荟萃分析（SRMA）的目的是评估困难气道与接受手术的阻塞性睡眠呼吸暂停（OSA）患者之间的关联证据。
从 1946 年到 2017 年 4 月，标准数据库被搜索以确定合格的文章。纳入的研究必须包括患有疑似或确诊阻塞性睡眠呼吸暂停的成年手术患者，并且必须报告至少 1 例困难气道事件[即困难插管（DI）、困难面罩通气（DMV）、未能插入声门上气道或困难手术气道]在睡眠呼吸暂停和非睡眠呼吸暂停患者中。
总体而言，睡眠呼吸暂停患者的 DI 发生率是无睡眠呼吸暂停患者的 3.46 倍（OSA 与非 OSA：13.5%比 2.5%；OR 3.46；95%CI：2.32-5.16，p<0.00001）。睡眠呼吸暂停患者的 DMV 发生率是无睡眠呼吸暂停患者的 3.39 倍（OSA 与非 OSA：4.4%比 1.1%；OR 3.39；95%CI：2.74-4.18，p<0.00001）。OSA 患者的 DI 和 DMV 联合发生率是非 OSA 患者的 4.12 倍（OSA 与非 OSA：1.1%比 0.3%；OR 4.12；95%CI：2.93-5.79，p<0.00001）。在睡眠呼吸暂停患者与非睡眠呼吸暂停患者之间，声门上气道失败率无显著差异（OR：1.34；95%CI：0.70-2.59；p=0.38）。进行元回归以调整各种亚组和基线混杂因素对最终结果的推断没有影响。
本 SRMA 发现，与非睡眠呼吸暂停患者相比，阻塞性睡眠呼吸暂停患者在插管或面罩通气或两者都困难方面的风险增加了三到四倍。
