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Is Mallampati scoring and PPNC an easier and better predictor for Obstructive Sleep Apnea (OSA)?

Background: Obstructive sleep apnea is a spectrum of sleep disturbances that cause short term and long-term effects including development of Type II diabetes mellitus, metabolic syndrome, hypertension and coronary artery disease.Mallampati score (MP) and percent predicted neck circumference (PPNC) together is considered to predict obstructive sleep apnea. The objective of the study is to assess the validity of PPNC and MP in the prediction of OSA. Material and methods: The study was a cross sectional study conducted among software professionals belong to Information Technology (IT) firms of Chennai. A total of 71 participants were included. All study participants were screened with berlin questionnaire and assessed with modified Mallampati scoring and overnight type IV polysomnography. PPNC was calculated. Predictive ability was assessed with ROC curve analysis, sensitivity, specificity, positive predictive value and negative predictive value. Results: Among the study participants,86% were males and 14% were females. 21% belong to normal BMI. Mean(SD) of BMI,Neck circumference and PPNC was 26.2 (3.77), 37.97(3.48) and 94.23 (8.17) respectively.AUC for PPNC was 0.59(0.46-0.72); Sensitivity of PPNC was 70% and specificity 48.78%, positive predictive value of 50% and negative predictive value of 68.97%. AUC for Mallampati Score was 0.57(0.44-0.71). Sensitivity of MMS in prediction of OSA was 40% and specificity 75.61% with a positive predictive value of 54.55% and negative predictive value of 63.27%. AUC for MMS and PPNC together was 0.843 (0.738-0.949), which was good enough. (p value=0.000); sensitivity of MMS and PPNC in prediction of OSA was 90% and specificity 77.77% with a positive predictive value of 86.95% and negative predictive value of 84%.Conclusion:Though individually MMS and PPNC have fair predictive ability, their combined predictive ability is much higher.