title: Anaesthetic management of sleep-disordered breathing in adults.
abstract: Anaesthesia and sleep are different states of unconsciousness with considerable physiological common ground. Because of their shared depressant effects on muscle activation and ventilatory drive, patients with anatomically compromised airways will tend to obstruct in either state and those with impaired ventilatory capacity will tend to hypoventilate. Breathing behaviour in one state is predictive of that in the other. An essential difference is that while arousal responses are preserved during sleep, they are depressed during sedation and abolished by anaesthesia. This renders patients with sleep-related breathing disorders vulnerable to hypoventilation and asphyxia when deeply sedated. Addressing this vulnerability requires a systematic approach to identification of patients and circumstances that magnify this risk, and methods of managing it that seek to reconcile the need for safety with cost-effective use of resources.
authors.affiliation: Centre for Sleep Science, University of Western Australia, Perth, Western Australia, Australia.|Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors.forename: David R
authors.initials: DR
authors.lastname: Hillman
authors.affiliation: Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Frances
authors.initials: F
authors.lastname: Chung
mesh_terms: D000328:Adult; D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods*; D001143:Arousal; D001237:Asphyxia / Q000209:etiology; D006801:Humans; D007040:Hypoventilation / Q000209:etiology; D012307:Risk Factors; D012890:Sleep / Q000502:physiology*; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000503:physiopathology*
keywords: anaesthesia; obstructive sleep apnoea; perioperative management; sleep; sleep-disordered breathing