Perioperative treatment of patients with obstructive sleep apnea.
OBJECTIVE
Obstructive sleep apnea is a common disorder. Despite reports of its role as a risk factor for postoperative morbidity and mortality, only a few investigators have examined the optimal treatment of patients during this vulnerable period. Recognition of obstructive sleep apnea during conscious sedation or in the perioperative period is important to prevent the occurrence of adverse outcomes. This review discusses the influence of sedative, anesthetic, and analgesic agents and other factors during the perioperative period on patients with obstructive sleep apnea. The aim of this article is to emphasize the importance of recognizing and appropriately treating surgical patients with obstructive sleep apnea.


RESULTS
Sedative, analgesic, and anesthetic agents used perioperatively play a major role in the development of sleep-disordered breathing during the postoperative period. Postoperative apneic episodes frequently occur even after surgery remote from the upper airway. Sleep apnea predisposes patients to a greater than normal risk for postsurgical complications. Adequate screening of patients preoperatively and initiation of continuous positive airway pressure therapy perioperatively could prevent serious complications, including hypoxemia, arrhythmias, myocardial infarction, and respiratory arrest.


CONCLUSIONS
Obstructive sleep apnea places a significant proportion of surgical patients at increased risk of perioperative complications. Obstructive sleep apnea can be induced, unmasked, or exacerbated by the effects of sedative, analgesic, and anesthetic agents regardless of the site of surgery. The role of sleep apnea as a risk factor for development of postoperative complications needs greater emphasis. Increased awareness of the risk posed by an obstructed upper airway and appropriate management are important to optimize the perioperative care of patients with obstructive sleep apnea.
Jain
Sanjay S
SS
Division of Pulmonary, Critical Care and Environmental Medicine, University of Missouri-Columbia and Harry S. Truman VA Hospital, Columbia, Missouri 65212, USA. jains@health.missouri.edu
Dhand
Rajiv
R
D000700:Analgesics / Q000627:therapeutic use*; D000777:Anesthetics / Q000008:administration & dosage*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D011183:Postoperative Complications; D011229:Preanesthetic Medication; D011300:Preoperative Care; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology*; D013514:Surgical Procedures, Operative
D000700:Analgesics; D000777:Anesthetics; D006993:Hypnotics and Sedatives