It has been known that obstructive sleep apnea (OSA) is strongly associated with difficult airways, however the detailed relationship has not been clearly defined in a comprehensive review previously. The group from Toronto Western Hospital undertook a review of English-language literature up to April 2016 to determine the association between OSA and difficult airways. Ten studies were included for the qualitative analysis. The incidence of difficult tracheal intubation was found to be 2-fold higher in OSA patients versus non-OSA patients (14.5% vs. 7.7%; p=0.0002). Difficult mask ventilation occurred 3.5X more in OSA patients (2.5% vs. 0.7%; p<0.0001). This study did not find a difference in airway management difficulty with supraglottic airway devices (1.5% vs. 1.1%; p=0.38). The narrative review determined that OSA is indeed a risk factor for difficult airway.