Development and Validation of a Morphological Preoperative Obstructive Sleep Apnea Prediction Score: The DES-OSA Score

SESSION TITLE: OSA Posters SESSION TYPE: Poster Presentations PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM 02:15 PM PURPOSE: Obstructive Sleep Apnea (OSA) increases the perioperative risk. We develop a preoperative prediction score based on morphological characteristics. METHODS: Following IRB approvals and informed consent, we included 149 patients scheduled for an overnight polysomnography (OPS). Before OPS, we measured several morphological metrics of their body, face, and neck. According to their value, each of them received a 1, 2 or 3 point(s) score. After the OPS, the AHI (Apnea Hypopnea Index: number of apnea and hypopnea per hour) was collected. Different combinations of morphological metric scores were then summed and tested for their ability to predict a severe OSA (AHI>30). This ability was calculated using ROC curve analysis and prediction probability (PK). A two-tailed P value lower than 0.05 was considered significant. RESULTS: 10 patients were excluded. The best prediction score take account of four parameters: the Mallampati score, the distance between the thyroid and the chin (DTC), the body mass index (BMI) and the neck circumference (NC). According to their value, the parameters were weighted as following (1 point, 2 points, 3 points): Mallampati (Class I, Class II, Class III et IV), DTC in cm (>6, 5-6, 28, >39, >41), NC in cm (>37, >42, >48). The PK for an AHI>30 was 0.868 (95% CI: 0.81-0.92). The area under the curve was 0.83 (95% CI: 0.735-0.926). Sensitivity (Se) and Specificity (Sp), expressed in %, were 100 (Se) and 28.1 (Sp) for a summed score > 3, 73.1 (Se) and 78.9 (Sp) for a summed score >5, and 53.8 (Se) and 94.7 (Sp) for a summed score >6, respectively. CONCLUSIONS: Our study defines a simple morphological score for detecting OSA patients. A score > 3 presents a sensitivity of 100% and a score > 6 presents a specificity of 94.7% to identify an OSA patient with an AHI > 30. CLINICAL IMPLICATIONS: Anesthesiologists could use the DES-OSA score in order to detect OSA patients. The best clinical threshold is a score higher to 5 points. DISCLOSURE: The following authors have nothing to disclose: Eric Deflandre, Vincent Bonhomme, Stephanie Degey, Laurent Cambron, Robert Poirrier, Jean-Francois Brichant, Pol Hans No Product/Research Disclosure Information Copyright © 2014 American College of Chest Physicians