title: Obstructive Sleep Apnea: Preoperative Screening and Postoperative Care.
abstract: The incidence of obstructive sleep apnea (OSA) has reached epidemic proportions, and it is an often unrecognized cause of perioperative morbidity and mortality. Profound hypoxic injury from apnea during the postoperative period is often misdiagnosed as cardiac arrest due to other causes. Almost a quarter of patients entering a hospital for elective surgery have OSA, and >80% of these cases are undiagnosed at the time of surgery. The perioperative period puts patients at high risk of apneic episodes because of drug effects from sedatives, narcotics, and general anesthesia, as well as from the effects of postoperative rapid eye movement sleep changes and postoperative positioning in the hospital bed. For adults, preoperative screening using the STOP or STOP-Bang questionnaires can help to identify adult patients at increased risk of OSA. In the pediatric setting, a question about snoring should be part of every preoperative examination. For patients with known OSA, continuous positive airway pressure should be continued postoperatively. Continuous pulse oximetry monitoring with an alarm system can help to prevent apneic catastrophes caused by OSA in the postoperative period.
authors.affiliation: From the Department of Family Medicine, NorthShore University HealthSystem, Evanston, IL (RMW, RW-C); the University of Chicago Pritzker School of Medicine, Chicago, IL (RMW, JP, DEM, RW-C); the Department of Otolaryngology, NorthShore University HealthSystem, Evanston, IL (JP); University of Chicago (NorthShore) Family Medicine Residency, Glenview, IL (DEM); and Clinical Research Informatics, Center for Biomedical Research Informatics; NorthShore University HealthSystem, Evanston, IL (TS). rwolfe1@uchicago.edu.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Wolfe
authors.affiliation: From the Department of Family Medicine, NorthShore University HealthSystem, Evanston, IL (RMW, RW-C); the University of Chicago Pritzker School of Medicine, Chicago, IL (RMW, JP, DEM, RW-C); the Department of Otolaryngology, NorthShore University HealthSystem, Evanston, IL (JP); University of Chicago (NorthShore) Family Medicine Residency, Glenview, IL (DEM); and Clinical Research Informatics, Center for Biomedical Research Informatics; NorthShore University HealthSystem, Evanston, IL (TS).
authors.forename: Jonathan
authors.initials: J
authors.lastname: Pomerantz
authors.affiliation: From the Department of Family Medicine, NorthShore University HealthSystem, Evanston, IL (RMW, RW-C); the University of Chicago Pritzker School of Medicine, Chicago, IL (RMW, JP, DEM, RW-C); the Department of Otolaryngology, NorthShore University HealthSystem, Evanston, IL (JP); University of Chicago (NorthShore) Family Medicine Residency, Glenview, IL (DEM); and Clinical Research Informatics, Center for Biomedical Research Informatics; NorthShore University HealthSystem, Evanston, IL (TS).
authors.forename: Deborah E
authors.initials: DE
authors.lastname: Miller
authors.affiliation: From the Department of Family Medicine, NorthShore University HealthSystem, Evanston, IL (RMW, RW-C); the University of Chicago Pritzker School of Medicine, Chicago, IL (RMW, JP, DEM, RW-C); the Department of Otolaryngology, NorthShore University HealthSystem, Evanston, IL (JP); University of Chicago (NorthShore) Family Medicine Residency, Glenview, IL (DEM); and Clinical Research Informatics, Center for Biomedical Research Informatics; NorthShore University HealthSystem, Evanston, IL (TS).
authors.forename: Rebecca
authors.initials: R
authors.lastname: Weiss-Coleman
authors.affiliation: From the Department of Family Medicine, NorthShore University HealthSystem, Evanston, IL (RMW, RW-C); the University of Chicago Pritzker School of Medicine, Chicago, IL (RMW, JP, DEM, RW-C); the Department of Otolaryngology, NorthShore University HealthSystem, Evanston, IL (JP); University of Chicago (NorthShore) Family Medicine Residency, Glenview, IL (DEM); and Clinical Research Informatics, Center for Biomedical Research Informatics; NorthShore University HealthSystem, Evanston, IL (TS).
authors.forename: Tony
authors.initials: T
authors.lastname: Solomonides
mesh_terms: D000234:Adenoids / Q000473:pathology; D000328:Adult; D000768:Anesthesia, General / Q000009:adverse effects; D002648:Child; D006801:Humans; D006984:Hypertrophy / Q000150:complications; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use; D009294:Narcotics / Q000009:adverse effects / Q000627:therapeutic use; D010092:Oximetry; D014066:Palatine Tonsil / Q000473:pathology; D056888:Patient Positioning / Q000009:adverse effects; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011300:Preoperative Care; D012131:Respiratory Insufficiency / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000175:diagnosis* / Q000209:etiology; D012913:Snoring / Q000175:diagnosis / Q000503:physiopathology; D011795:Surveys and Questionnaires
chemical_list: D006993:Hypnotics and Sedatives; D009294:Narcotics
keywords: Obstructive Sleep Apnea; Opioids; Pediatrics; Respiratory Failure; Respiratory Tract Diseases; Screening; Sleep Disorders; Snoring; Surgery