title: Perioperative management of obstructive sleep apnea: a systematic review.
abstract: Obstructive sleep apnea (OSA) is the leading sleep disordered breathing condition, with a prevalence rate of moderate to severe OSA of approximately 10-17% in the general population.
  
  
  
  We performed an Ovid-Medline search of all articles published up to August 2016. We included all articles providing updated evidence on epidemiology, pathophysiologic mechanisms and perioperative interventions.
  
  
  
  OSA is associated with a number of comorbidities and increased perioperative risks. Although in-laboratory polysomnography represents the gold-standard for diagnosis of OSA, it is costly and time-consuming. Anesthesiologists may screen patients for OSA through one of the available questionnaires, of which the snoring, tiredness, observed apnea, high blood pressure (STOP)-Body Mass Index, age, neck circumference and gender (Bang), STOP-bang questionnaire is the most externally validated. Although its sensitivity for the identification of mild OSA patients is 83.6%, its specificity is only 56.4%. OSA patients are associated with a higher risk of both difficult ventilation and intubation. However, practice guidelines refer to available guidelines for difficult airway management. Perioperative continuous positive airway pressure use may be of benefit since it has been reported to be associated with a reduction of both respiratory and cardiovascular complications and symptom relief. When feasible, regional anesthesia techniques and a multimodal analgesia approach should be adopted to reduce intraoperative and postoperative exposure to opioids.
  
  
  
  Preoperative screening of OSA patients is of relevance given the increased perioperative morbidity of these patients. Further studies are needed to provide conclusive data on which perioperative interventions are most effective at reducing this risk.
authors.affiliation: Section of Anesthesia and Intensive Care, Emergency Department, &quot;GB Morgagni-L. Pierantoni&quot; Hospital, Forlì, Forlì-Cesena, Italy.
authors.forename: Ruggero
authors.initials: R
authors.lastname: Corso
authors.affiliation: Section of Anesthesia, Analgesia, Intensive Care and Emergency, Department of Biopathology and Medical Biotechnologies (DIBIMED), University Hospital Paolo Giaccone, University of Palermo, Palermo, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Russotto
authors.affiliation: Section of Anesthesia, Analgesia, Intensive Care and Emergency, Department of Biopathology and Medical Biotechnologies (DIBIMED), University Hospital Paolo Giaccone, University of Palermo, Palermo, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Gregoretti
authors.affiliation: UTHealth, McGovern Medical School Houston, TX, USA - davide.cattano@uth.tmc.edu.
authors.forename: Davide
authors.initials: D
authors.lastname: Cattano
mesh_terms: D045422:Continuous Positive Airway Pressure; D006801:Humans; D010149:Postoperative Pain / Q000517:prevention & control; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000628:therapy*