Perioperative Management of Obstructive Sleep Apnea

Abstract

Numerous studies have now described complications in patients with obstructive sleep apnea (OSA) associated with various types of surgical encounters both from the standpoint of anatomical location and timing of the surgery such as inpatient or outpatient. Cardiac, pulmonary, and cognitive events are the best studied but are sometimes ill-defined and difficult to equate between different investigators such that the data may appear conflicting and provides challenges to guideline development and management. This has resulted in variant national- and local-level protocols to address risk factor assessment and perioperative practice patterns. What seems to be clear is that increased postoperative events do occur in patients with OSA, more so in the presence of obesity hypoventilation, but the incidence of true mortality and serious morbidity seems to be low such that these outcomes remain the most poorly understood albeit still of significant interest. In the following review, we hope to present a balanced discussion of these issues to foster broader understanding and acceptance of the concerns arising from the perioperative management of patients with OSA and encourage further research to provide direction into the development of more uniform appropriate guidelines.