SynthesisPloS one2018
Is obstructive sleep apnea associated with difficult airway? Evidence from a systematic review and meta-analysis of prospective and retrospective cohort studies.
Synthesis in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 66 citations in OpenAlex.
- Explainable Machine-Learning Model for Predicting Severe Obstructive Sleep Apnea in Patients Undergoing Metabolic Bariatric Surgery.Obesity surgery · 2026Article
- Chinese Guidelines for the Diagnosis and Surgical Treatment of Adult Obstructive Sleep Apnea (2024).World journal of otorhinolaryngology - head and neck surgery · 2026Article
- The perioperative implications of the patient with Obstructive Sleep Apnea (OSA) - a narrative review.Future science OA · 2025Review
- Obstructive sleep apnea in adult ambulatory anesthesia: navigating guidelines and evidence for safe home discharge.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2025Article
- Assessment of Outcomes of Obstructive Sleep Apnea Management Involving OMFS and ENT Surgical Procedures: A Retrospective Study.Journal of pharmacy & bioallied sciences · 2025Article
- Comparison of NoSAS score with STOP-Bang and Berlin scores in predicting difficult airway.BMC anesthesiology · 2025Article
- German guidelines for airway management 2023.Die Anaesthesiologie · 2024Review
- Expert consensus on difficult airway assessment.Hepatobiliary surgery and nutrition · 2023Review
- Preoperative risk evaluation and perioperative management of patients with obstructive sleep apnea: a narrative review.Journal of dental anesthesia and pain medicine · 2023Review
- PREOPERATIVE SINGLE ANTHROPOMETRIC SCREENING TESTS OF DIFFICULT FACE MASK VENTILATION AND DIFFICULT DIRECT LARYNGOSCOPY INTUBATION IN PATIENTS UNDERGOING OTORHINOLARYNGOLOGICAL SURGERY: A PROSPECTIVE, OBSERVATIONAL, SINGLE CENTER STUDY.Acta clinica Croatica · 2023Observational
- Impact of obstructive sleep apnea on clinical outcomes in patients hospitalized with COVID-19.Sleep & breathing = Schlaf & Atmung · 2022Observational
- Usefulness of preoperative point-of-care ultrasound measurement of the lateral parapharyngeal wall to predict difficulty in mask ventilation.Proceedings (Baylor University. Medical Center) · 2022Article
- Neck Circumference Predicts Mortality in Hospitalized COVID-19 Patients.Infectious disease reports · 2021Article
- Utilization of apnea-hypopnea index as a novel predictive factor for difficult mask ventilation in the Chinese population under general anesthesia.Sleep & breathing = Schlaf & Atmung · 2021Article
- Obstructive Sleep Apnea, Obesity, and Noninvasive Ventilation: Considerations During the COVID-19 Pandemic.Anesthesia and analgesia · 2020Review
- Preoperative preparation and premedication of bariatric surgical patient.Saudi journal of anaesthesiaReview
- Evaluation of the relationship between the STOP-Bang score with oxygen reserve index and difficult airway: a prospective observational study.Brazilian journal of anesthesiology (Elsevier)Observational
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDifficult 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.
methodsThe 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.
resultsOverall, 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.
conclusionThis 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.