Evaluation of patients at risk for obstructive sleep apnea using the VIDIAC score in the preoperative period

Obstructive sleep apnea syndrome (OSAS) is considered one of the significant risk factors for a difficult airway. In recent years, the use of videolaryngoscopy has provided important advantages in predicting and managing difficult airway scenarios. In this prospective observational study, the relationship between preoperative airway assessment parameters and the VIDIAC score recorded during videolaryngoscopy was investigated in 164 patients undergoing elective surgery who were considered at high risk for OSAS with a NoSAS score ≥8. The Cormack-Lehane classification is widely used to grade glottic visualization during direct laryngoscopy; however, it may not fully reflect the actual intubation difficulties encountered during videolaryngoscopy. This study demonstrated that while the Cormack-Lehane grading provides only a categorical evaluation, the VIDIAC score offers a more objective prediction of intubation difficulty by quantifying the glottic view. Our findings revealed that male gender, increased neck circumference, high body mass index (BMI), history of snoring, high Mallampati score, and Cormack-Lehane grade III–IV were significantly associated with an increased likelihood of a difficult airway. When patients were divided into two groups according to their VIDIAC scores (≤1 and ≥2), it was found that a higher VIDIAC score was significantly associated with longer intubation time, the need for additional maneuvers, and the requirement for more than one operator (p<0.05). In particular, higher Cormack-Lehane grades (III–IV) were found to be consistent with higher VIDIAC scores, indicating that poor glottic exposure correlates well with higher numerical scores. Statistical analyses confirmed that an increase in the VIDIAC score was significantly related to these clinical challenges (p<0.05). Additionally, although there was a trend towards a higher incidence of intraoperative airway trauma in patients with a VIDIAC score ≥2, this difference was not statistically significant (p=0.084). However, when postoperative airway complications such as sore throat and hoarseness were evaluated after extubation, a significant difference was observed (p=0.003); these complications were more frequently seen in patients with higher VIDIAC scores. In conclusion, performing intubation with a videolaryngoscope in patients at high risk for OSAS facilitates airway management. The VIDIAC score, as a complementary tool to the Cormack-Lehane classification, offers the opportunity to objectively and comprehensively evaluate the glottic view. It is considered that adding the VIDIAC score to digital patient records may contribute to enhanced patient safety in future anesthesia planning, appropriate equipment preparation, and difficult airway management.