Implications and Interventions Related to Obstructive Sleep Apnea

Care of the Surgical Patient With Obstructive Sleep Apnea

“…Obstructive sleep apnea (OSA) can have a profound effect on the surgical patient's morbidity and mortality 1‐3 . The surgical patient population has more cases of undiagnosed OSA than the general population, placing surgical patients at risk for difficult airway management, increased intensive care unit admissions, increased health care costs, 2 and post‐discharge death 4 .…”

“…According to the literature, 80% to 82% of men and 92% to 93% of women with moderate to severe sleep apnea are undiagnosed 2,3,5 . In addition, surgical patients who have OSA are at increased risk for negative outcomes during the perioperative continuum that include hypercapnia, oxygen desaturation, difficult intubation and reintubation, cardiac arrhythmias, delirium, increased length of stay, and cardiac arrest 1 …”

“…Obstructive sleep apnea is defined as the cessation of breathing while sleeping and is associated with decreased muscle tone in the airway, which leads to frequent airway obstruction 2 . The clinical definition of apnea is continued ventilatory effort with absence of airflow for at least 10 seconds 1 . Hypopnea (ie, abnormally slow or shallow breathing) occurs when airflow is reduced by at least 30% from baseline and oxygen saturation is reduced by 4% or more, both lasting at least 10 seconds 1 .…”

“…The clinical definition of apnea is continued ventilatory effort with absence of airflow for at least 10 seconds 1 . Hypopnea (ie, abnormally slow or shallow breathing) occurs when airflow is reduced by at least 30% from baseline and oxygen saturation is reduced by 4% or more, both lasting at least 10 seconds 1 . The American Society of Anesthesiologists describes OSA as a respiratory condition that typically requires the use of continuous positive airway pressure (CPAP) at home 6,7 .…”

“…The occurrence of OSA is on the rise in the United States, 4 with recent trends identified in the obese patient population and even higher OSA rates in the severely obese patient population 2 . Studies indicate that one in five adults has mild sleep apnea and one in 15 adults has moderate sleep apnea 1 . Between 75% and 90% of patients with OSA are undiagnosed, which may be related to the challenges of the screening process and could leave patients without treatment 1,6 …”