Prediction of obstructive sleep apnea using visual photographic analysis.
OBJECTIVE
Obstructive sleep apnea (OSA) has been historically underdiagnosed and may be associated with grave perioperative complications. The ASA and American Academy of Sleep Medicine recommend OSA screening prior to surgery; however, only a minority of patients are screened. The objective of this study was to determine the proficiency of anesthesiologists, otolaryngologists, and internists at predicting the presence of OSA by visual photographic analysis without the use of a computer program to assist, and determine if prediction accuracy varies by provider type.


METHODS
Prospective case series


METHODS
Tertiary care hospital-based academic center


METHODS
Fifty-six consecutive patients presenting to the sleep laboratory undergoing polysomnography had frontal and lateral photographs of the face and torso taken.


METHODS
Not applicable.


METHODS
Polysomnography outcomes and physician ratings. An obstructive apnea hypopnea index (oAHI) ≥15 was considered "positive." Twenty anesthesiologists, 10 otolaryngologists, and 11 internists viewed patient photographs and scored them as OSA "positive" or "negative" before and after being informed of patient comorbidities.


RESULTS
Nineteen patients had an oAHI <15, 18 were ≥15 but <30, and 19 were ≥30. The mean oAHI was 28.7 ± 26.7 events/h (range, 0-125.7), and the mean body mass index was 34.1 ± 9.7 kg/m(2) (range, 17.4-63.7). Overall, providers predicted the correct answer with 61.8% accuracy without knowledge of comorbidities and 62.6% with knowledge (P < .0001). There was no difference between provider groups (P = .307). Prediction accuracy was unrelated to patient age (P = .067), gender (P = .306), or race (P = .087), but was related to body mass index (P = .0002).


CONCLUSIONS
The ability to predict OSA based on visual inspection of frontal and lateral photographs is marginally superior to chance and did not differ by provider type. Knowledge of comorbidities did not improve prediction accuracy.
Department of Anesthesia & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Kristin
K
Cheung
Division of Otolaryngology-Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: drishman@yahoo.com.
Stacey L
SL
Ishman
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
James R
JR
Benke
Emory Sleep Center, Emory University, Atlanta, GA, USA.
Nancy
N
Collop
Department of Anesthesiology, Lankenau Hospital, Wynnewood, PA, USA.
Lia
L
Tron
Department of Anesthesia & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Nicole
N
Moy
Department of Anesthesia & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Tracey L
TL
Stierer
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005145:Face; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010781:Photography; D011446:Prospective Studies; D015203:Reproducibility of Results; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D060726:Torso; D055815:Young Adult
Facial analysis; Obstructive sleep apnea; Photogrammetry; Photographic; Prediction; Sleep apnea