Inspiratory mallampati: a novel extension of modified mallampati for enhanced airway assessment

<bold>Introduction:</bold> Obstructive sleep apnea (OSA) syndrome entails recurrent upper airway obstruction during sleep, primarily at the pharyngeal level (soft palate and/or posterior base of the tongue). The Mallampati score (MS) evaluates oropharyngeal structures' visibility, focusing on the soft palate, tongue, and uvula. <bold>Methods:</bold> Between 2018 and 2024, 925 subjects underwent type 1 polysomnography (PSG). MS was assessed at maximal mouth opening and then with maximal oral inspiration (Inspiratory Mallampati score (I-MS)) in an upright standard position. Nasion-subnasal distance (N-SN) is also measured. Patients with AHI ≥ 15/hour, indicative of cardiovascular complications, were categorized as the patient (P) group, while those with AHI < 15/hour served as the control (C) group. <bold>Results:</bold> Average age of participants was 52.4±15.5 years, predominantly males (72.7%). 642 patients (69.5%) had an AHI ≥ 15. Partial reversibility of I-MS was observed in 76.6% of the population. I-MS distribution of P group were 105 patients (37.2%) in class I, 121 patients (42.9%) in class II, 52 patients (18.4%) in class III and 4 patients (1.42%) in class IV compared to C group were 158 patients (24.6%) in class I, 294 patients (45.8%) in class II, 172 patients (26.79%) in class III and 18 patients (2.8%) were in class IV respectively; p-value < 10-3. N-SN was identical in P group (52.1±6.8 cm) compared to (51.4±6.9 cm) in C group (p-value = 0.15). <bold>Conclusion:</bold> I-MS predicts better the risk of moderate to severe OSA. This underscores the need for updating the standard MS by incorporating the I-MS assessment.