Perioperative management of obstructive sleep apnea.
Obstructive sleep apnea (OSA) is the most common breathing disorder, with a high prevalence in both the general and surgical populations. OSA is frequently undiagnosed, and the initial recognition often occurs during medical evaluation undertaken to prepare for surgery. Adverse respiratory and cardiovascular outcomes are associated with OSA in the perioperative period; therefore, it is imperative to identify and treat patients at high risk for the disease. In this review, we discuss the epidemiology of OSA in the surgical population and examine the available data on perioperative outcomes. We also review the identification of high-risk patients using clinical screening tools and suggest intraoperative and postoperative treatment regimens. Additionally, the role of continuous positive airway pressure in perioperative management of OSA and a brief discussion of ambulatory surgery in patients with OSA is provided. Finally, an algorithm to guide perioperative management is suggested.
Departments of Anesthesiology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA. Adebola.Adesanya@UTSouthwestern.edu
Adebola O
AO
Adesanya
Won
W
Lee
Nancy B
NB
Greilich
Girish P
GP
Joshi
D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D045422:Continuous Positive Airway Pressure / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods*