Mallampati Score and Pediatric Obstructive Sleep Apnea

Kumar, Harsha; Schroeder, James W.; Zhang, Gang; Sheldon, Stephen H.

doi:10.5664/jcsm.4032

Cited by 62 publications

(25 citation statements)

References 38 publications

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“…Hirsch et al found that children who were obese and undergoing PSA experienced a greater desaturation rate compared with children who were not obese (9.9% vs 5.4%; p=0.04). 27 Furthermore, Mallampati scores have also been shown to be an independent predictor of obstructive sleep apnea, thus highlighting the fact that these scores may be an indirect measurement of anatomical factors that should be considered in pre-PSA assessments. 28…”

Section: Discussionmentioning

confidence: 99%

Higher Mallampati Scores Are Not Associated with More Adverse Events During Pediatric Procedural Sedation and Analgesia

Iyer¹,

Pitetti²,

Vitale³

2018

WestJEM

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IntroductionProcedural sedation and analgesia (PSA) is used by non-anesthesiologists (NAs) outside of the operating room for several types of procedures. Adverse events during pediatric PSA that pose the most risk to patient safety involve airway compromise. Higher Mallampati scores may indirectly indicate children at risk for airway compromise. Medical governing bodies have proposed guidelines for PSA performed by NAs, but these recommendations rarely suggest using Mallampati scores in pre-PSA evaluations. Our objective was to compare rates of adverse events during pediatric PSA in children with Mallampati scores of III/IV vs. scores of Mallampati I/II.MethodsThis was a prospective, observational study. Children 18 years of age and under who presented to the pediatric emergency department (PED) and required PSA were enrolled. We obtained Mallampati scores as part of pre-PSA assessments. We defined adverse events as oxygen desaturation < 90%, apnea, laryngospasm, bag-valve-mask ventilation performed, repositioning of patient, emesis, and “other.” We used chi-square analysis to compare rates of adverse events between groups.ResultsWe enrolled 575 patients. The median age of the patients was 6.0 years (interquartile range = 3.1,9.9). The primary reasons for PSA was fracture reduction (n=265, 46.1%). Most sedations involved the use of ketamine (n= 568, 98.8%). Patients with Mallampati scores of III/IV were more likely to need repositioning compared to those with Mallampati scores of I/II (p=0.049). Overall, patients with Mallampati III/IV scores did not experience a higher proportion of adverse events compared to those with Mallampati scores of I/II. The relative risk of any adverse event in patients with Mallampati scores of III/IV (40 [23.8%]) compared to patients with Mallampati scores of I/II (53 [18.3%]) was 1.3 (95% confidence interval [0.91–1.87]).ConclusionPatients with Mallampati scores of III/IV vs. Mallampati scores of I/II are not at an increased risk of adverse events during pediatric PSA. However, patients with Mallampati III/IV scores showed an increased need for repositioning, suggesting that the sedating physician should be vigilant when performing PSA in children with higher Mallampati scores.

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Section: Discussionmentioning

confidence: 99%

Higher Mallampati Scores Are Not Associated with More Adverse Events During Pediatric Procedural Sedation and Analgesia

Iyer¹,

Pitetti²,

Vitale³

2018

WestJEM

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“…38,39 Finally, although our study did not reveal Mallampati score and tonsil size as predictors of OSA, a recent retrospective study has shown them to be significant predictors of pediatric OSA, particularly when Mallampati score is measured supine. 40 The interplay of these factors with BMI and body fat distribution, as well the reliability of scoring and assessing Mallampati and tonsil scores, require further evaluation in future studies.…”

Section: Discussionmentioning

confidence: 99%

Does Neck-to-Waist Ratio Predict Obstructive Sleep Apnea in Children?

Katz

Vaccani

Barrowman

et al. 2014

Journal of Clinical Sleep Medicine

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Objectives: Central adiposity and large neck circumference are associated with obstructive sleep apnea (OSA) in adults but have not been evaluated in children as predictors of OSA. Study objectives were to determine whether (1) anthropometric measures including neck-to-waist ratio are associated with OSA in older children; (2) body fat distribution, measured by neck-to-waist ratio, is predictive of OSA in overweight/obese children. Methods: Cross-sectional study involving children 7-18 years scheduled to undergo polysomnography at a tertiary care children's hospital. OSA was defi ned as total apnea-hypopnea index > 5 events/h and/or obstructive apnea index > 1 event/h. Recursive partitioning was used to select candidate predictors of OSA from: age, sex, height and weight percentile, body mass index (BMI) z-score, neck-to-waist ratio, tonsil size, and Mallampati score. These were then evaluated using log binomial models and receiver operator characteristic analysis. Results: Two hundred twenty-two participants were included; 133 (60%) were overweight/obese, 121 (55%) male,47 (21%) had OSA. Neck-to-waist ratio (relative risk [RR] 1.97 per 0.1 units, 95% CI 1.48 to 2.84) and BMI z-score (RR 1.63 per unit, 95% CI 1.30 to 2.05) were identifi ed as independent predictors of OSA. Considering only overweight/obese children, neckto-waist ratio (RR 2.16 per 0.1 units, 95% CI 1.79 to 2.59) and BMI z-score (RR 2.02 per unit, 95% CI 1.25 to 3.26) also independently predicted OSA. However, in children not overweight/obese, these variables were not predictive of OSA. Conclusions: Neck-to-waist ratio, an index of body fat distribution, predicts OSA in older children and youth, especially in those who were overweight/obese.

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“…As demonstrated in this pilot study, it can be extremely useful to look at the Mallampati index since Mallampati score has been found to have a strong linear correlation with AHI. In fact, in children, a high Mallampati score is more predictive of the presence of OSAS than in adults because the main cause of the obstruction is pharyngeal [25].…”

Section: Discussionmentioning

confidence: 99%

Sleep Abnormalities and Sleep Breathing Disorders in Children with Drug- Resistant Catastrophic Epileptic Encephalopathy

Gaeta¹

2015

J Sleep Disord Ther

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Undiagnosed obstructive sleep apnoea is common in patients with medically refractory epilepsy. The aim of this study is to evaluate sleep alterations and the prevalence of Sleep Breathing Disorders (SBD) in a paediatric population with catastrophic epileptic encephalopathy. To diagnose SBD, polysomnography (PSG) was performed in eleven patients (nine males, two females), with ages ranging between 3 and 11 years old, with epileptic encephalopathy characterized by drug-resistant seizures, occurring both in sleeping and waking, mental retardation and cerebral palsy. All the patients presented alterations of the sleep architecture and were positive for SBD. In particular, seven patients presented a severe form of Obstructive Sleep Apnoea Syndrome (OSAS) with apnoea/ hypopnea index (AHI) greater than10/hr, two patients presented a moderate form with AHI between 5/hr and 10/hr, two patients presented a mild form with AHI lower than 4/hr. In conclusion, SBD and sleep disruption appeared to be in comorbidity with catastrophic epileptic encephalopathy. Their treatment might also have a positive impact in seizures control and quality of life.

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Mallampati Score and Pediatric Obstructive Sleep Apnea

Cited by 62 publications

References 38 publications

Higher Mallampati Scores Are Not Associated with More Adverse Events During Pediatric Procedural Sedation and Analgesia

Higher Mallampati Scores Are Not Associated with More Adverse Events During Pediatric Procedural Sedation and Analgesia

Does Neck-to-Waist Ratio Predict Obstructive Sleep Apnea in Children?

Sleep Abnormalities and Sleep Breathing Disorders in Children with Drug- Resistant Catastrophic Epileptic Encephalopathy

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