Perioperative sleep apnea: a real problem or did we invent a new disease?

Abstract

Depending on the subpopulation, obstructive sleep apnea (OSA) can affect more than 75% of surgical patients. An increasing body of evidence supports the association between OSA and perioperative complications, but some data indicate important perioperative outcomes do not differ between patients with and without OSA. In this review we will provide an overview of the pathophysiology of sleep apnea and the risk factors for perioperative complications related to sleep apnea. We also discuss a clinical algorithm for the identification and management of OSA patients facing surgery.

Keywords: Anaesthesiology; Bariatric surgery; Obstructive sleep apnea; Perioperative sleep apnea; Upper airway.

Figure 1.. Perioperative upper airway patency.

Respiratory arousal (grey hexagon) consisting of cortically and subcortically generated excitatory activity increases airway dilator muscle activity, thereby increasing upper airway dilating forces (green arrows). This counteracts the upper airway constricting forces (red arrows) generated by surrounding tissue pressure and negative intraluminal pressure during inspiration. (UA=upper airway yellow).

Figure 2.. Algorithm for the perioperative detection and management of patients with sleep apnea (Y=yes; N=no).

(modified from Zaremba S, Chamberlin NL, Eikermann M in Miller's Anesthesia 8th Edition, by Miller RD. Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL).