Modified Mallampati Score as a Predictor for the Presence and the Severity of Obstructive Sleep Apnea in Snoring Patients

*Ibrahim Eldosky
Medicine, Al-Azhar University, Department Of ENT, Al-Azhar University, Cairo, Egypt

*Corresponding Author:
Ibrahim Eldosky
Medicine, Al-Azhar University, Department Of ENT, Al-Azhar University, Cairo, Egypt

Published on: 2021-03-30


Aim of the study: To assess if the modified Mallampati score (MMS) can predict the presence and the severity of obstructive sleep apnea syndrome (OSA) in a group of patients who had snoring and witnessed apnea from Al-Azhar university hospitals, Cairo, Egypt and Almoosa Hospital, Alhasa, Saudi Arabia.

Methods: A retrospective study was done for patients who had snoring and witnessed apnea referred to a sleep lab for the diagnosis of OSA by overnight full polysomnogram from January 2017 to November 2020. Apnea-hypopnea index (AHI) was used to categorize the severity of sleep apnea. Age, sex, MMS, body mass index (BMI), comorbidities, sleep and laboratory parameters were recorded. Also, full Otorhinolaryngological, Neurological and Internal medicine examinations were recorded.

Results: The study was carried out on 350 patients fulfilling the inclusion criteria with a mean age 51.3 ± 14.3 years ranging from 14 to 81 years. More than half of them (58.6%) were males, the mean BMI was 35.1 ± 8.8 kg/m2 and the mean MMS was 4.7 ± 1.6 with about 65% of patients grouped in classes III and IV. OSA (AHI>5) was diagnosed in 278 (79.4%) patients. Significantly, OSA was more detected among males, those with increased age, BMI, MMS, and those with type 2 diabetes mellitus (T2DM). 


Snoring; Modified Mallampati Score; Body Mass Index; Obstructive Sleep Apnea


Sleep-disordered breathing (SDB) is the upper-airway obstruction occurring during sleep that was first demonstrated within the 1960s. SDB represents a gaggle of physiopathologic conditions characterized by an abnormal respiratory pattern during sleep which can be isolated or can coexist with other respiratory, nervous, cardiovascular, or endocrine diseases. SDB is widely prevalent within the general population [1,2]. SDB includes obstructive sleep apnea (OSA), which consists of breathing cessations of a minimum of 10 seconds occurring within the presence of inspiratory efforts during sleep. Central sleep apnea (CSA) consists of comparable apneas, but these instead happen within the absence of inspiratory efforts [3]. Complex (mixed) sleep apnea defined as a mixture of OSA with CSA or Cheyne-Stokes breathing pattern [4]. Upper-airway resistance syndrome (UARS) is characterized by snoring with increased resistance within the upper airway, leading to arousals during sleep [5]. OSA is the commonest sort of SDB and results in recurrent episodes of upper airway collapse during sleep which results in repetitive episodes of respiratory efforts associated with arousal, the symptoms of OSA are snoring, gasping and choking, witnessed apneas, insomnia, nocturia, restless sleep, excessive daytime sleepiness, morning headache, decreased concentration, and daytime fatigue [6]. Patients have OSA at an increased risk for hypertension, stroke, type 2 diabetes mellitus (T2DM), impaired cognitive function, motor car accidents, and occupational or social problems. To enhance the standard of life and to avoid morbidity and mortality associated with OSA, early diagnosis and treatment are important. The gold standard diagnostic tool is polysomnography (PSG) and it’s necessary for accurate diagnosis of OSA and to assess the treatment plan [7]. The predictors for OSA include obesity, increased neck circumference, craniofacial abnormalities, hypothyroidism, acromegaly, enlarged tonsil size, and a high Mallampati score [8]. Other risk factors for OSA are male gender, advanced age, and hypertension [9]. Several screening tools exist to assist in the identification of patients for apnea. There are four screening tools widely known as being fairly easy to administer: Stop, STOP-BANG (SB), Epworth Sleepiness Scale (ESS), and 4-Variable screening tool (4-V) [10]. The modified Mallampati score (MMS) helps to predict the convenience of endotracheal intubation. A high MMS (class 3 or 4) is related to harder intubation also as a better incidence of apnea [11,12]. A 2006 study showed that for every 1-unit increase within the MMS, the chances ratio of getting OSA (defined by an apnea-hypopnea index [AHI] >5) increased by 2.5. Additionally, the AHI increased by 5 events per hour [12]. The MMS is non-invasive and simply conducted in 15 seconds by trained healthcare providers. Hiremath et al. reported that the MMS is often a useful gizmo for subjects at high risk for OSA thanks to anatomical crowding of the oropharynx [13]. The aim of this study was to assess the value of the MMS to predict OSA among a gaggle of patients who had snoring and witnessed apnea

scroll up