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Obstructive sleep apnea (OSA) severity scoring system: American Society of Anesthesiologists example

	Points
A. Severity of sleep apnea based on sleep study (or clinical indicators if sleep study not available).
Severity of OSA
None (apnea hypopnea index [AHI]) 0 to 5 adults; 0 children)	0 points
Mild (AHI 6 to 20 adults; 1 to 5 children)	1 points
Moderate (AHI 21 to 40 adults; 6 to 10 children)	2 points
Severe (AHI greater than 40 adults; greater than 10 children)	3 points
Point score ____ (0 to 3)*^¶
B. Invasiveness of surgery and anesthesia.
Type of surgery and anesthesia
Superficial surgery under local or peripheral nerve block anesthesia without sedation	0 points
Superficial surgery with moderate sedation or general anesthesia	1 points
Peripheral surgery with spinal or epidural anesthesia (with no more than moderate sedation)	1 points
Peripheral surgery with general anesthesia	2 points
Airway surgery with moderate sedation	2 points
Major surgery, general anesthesia	3 points
Airway surgery, general anesthesia	3 points
Point score ____ (0 to 3)
C. Requirement for postoperative opioids.
Opioid requirement
None	0 points
Low-dose oral opioids	1 points
High-dose oral opioids, parenteral or neuraxial opioids	3 points
Point score ____ (0 to 3)
D. Estimation of perioperative risk. Overall score = the score for A plus the greater of the score for either B or C.
Total point score ____ (0 to 6)^Δ

* One point may be subtracted if a patient has been on continuous positive airway pressure or noninvasive positive pressure ventilation before surgery and will be using his or her appliance consistently during the postoperative period.
¶ One point should be added if a patient with mild or moderate obstructive sleep apnea (OSA) also has a resting arterial carbon dioxide tension (PaCO₂) greater than 50 mmHg.
Δ Patients with a score of 4 may be at increased perioperative risk from OSA; patients with a score of 5 or 6 may be at significantly increased perioperative risk from OSA.

Reproduced with permission from: American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Obstructive Sleep Apnea. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Obstructive Sleep Apnea. Anesthesiology 2006; 104:1081. Copyright © 2006 Lippincott Williams & Wilkins.

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