Prediction of obstructive sleep apnea using visual photographic analysis

Kristin Cheung; Stacey L Ishman; James R Benke; Nancy Collop; Lia Tron; Nicole Moy; Tracey L Stierer

doi:10.1016/j.jclinane.2015.12.020

Prediction of obstructive sleep apnea using visual photographic analysis

J Clin Anesth. 2016 Aug:32:40-6. doi: 10.1016/j.jclinane.2015.12.020. Epub 2016 Mar 22.

Authors

Kristin Cheung¹, Stacey L Ishman², James R Benke³, Nancy Collop⁴, Lia Tron⁵, Nicole Moy¹, Tracey L Stierer⁶

Affiliations

¹ Department of Anesthesia & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² 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.
³ Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Emory Sleep Center, Emory University, Atlanta, GA, USA.
⁵ Department of Anesthesiology, Lankenau Hospital, Wynnewood, PA, USA.
⁶ 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.

PMID: 27290943
DOI: 10.1016/j.jclinane.2015.12.020

Abstract

Study objectives: 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.

Design: Prospective case series

Setting: Tertiary care hospital-based academic center

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

Interventions: Not applicable.

Measurements: 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.

Main 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).

Conclusion: 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.

Keywords: Facial analysis; Obstructive sleep apnea; Photogrammetry; Photographic; Prediction; Sleep apnea.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Face
Female
Humans
Male
Middle Aged
Photography*
Prospective Studies
Reproducibility of Results
Sleep Apnea, Obstructive / diagnosis*
Torso
Young Adult