Year 2021
October 2021


Abstract Title
The Association of Obstructive Sleep Apnoea (OSA) and the Difficult Intubation (DI) – A Systematic Review and Meta-analysis



Khoo Teck Puat Hospital1

Background & Hypothesis

Retrospective and database studies linked OSA with DI in patients undergoing anaesthesia. OSA is commonly undiagnosed preoperatively, putting patients at risk of anticipated difficult airways and adverse outcomes. The STOP-Bang screening tool may be used to risk stratify patients with suspected OSA.

The objective of this systematic review is to determine the magnitude of the DI situation in patients diagnosed or suspected of OSA.


A literature review from January 1980 to May 2021 was performed in PubMed using several keywords alone or in combination “OSA”, “difficult intubation” and/or “difficult airway”, “anaesthesia:”, “surgery”, and “risk”.  

We explored the association between OSA and DI in adult patients undergoing anaesthesia and represented the data in a quantitative Forest plot. The odds ratio(OR) of DI was calculated for patients diagnosed with OSA and suspected of OSA based on STOP-Bang ≥3.


Fourteen studies with 6788 patients (10 observational studies and 4 case-control) were found. Overall, DI was 3.2-fold higher in OSA patients (OSA vs no OSA, OR3.20;95%CI2.24–4.57). Ten studies reported a significantly increased incidence of DI in OSA patients as compared to non-OSA patients. Challenges encountered in intubating OSA patients included difficult insertion of the laryngoscope blade and Cormack-Lehane grade ≥3. A STOP-Bang ≥3 was also associated with an increased incidence of DI (OR2.91;95%CI2.07–4.10).

Discussion & Conclusion

Based on the meta-analysis known and suspected OSA are associated with an increased risk of DI by more than 3-fold. Adequate preparations should be made for these vulnerable OSA patients to avoid adverse events.