Postoperative management of adults with obstructive sleep apnea
- Eric Olson, MD
Eric Olson, MD
- Associate Professor of Medicine
- Mayo Clinic College of Medicine
- Frances Chung, MBBS, FRCPC
Frances Chung, MBBS, FRCPC
- Professor, Department of Anesthesiology and Pain Management
- University Health Network
- University of Toronto
- Edwin Seet, MBBS, MMed
Edwin Seet, MBBS, MMed
- Clinical Senior Lecturer
- Yong Loo Lin School of Medicine, National University of Singapore
- Section Editors
- Stephanie B Jones, MD
Stephanie B Jones, MD
- Editor-in-Chief — Anesthesiology
- Section Editor — Anesthesia with Comorbid Non-Cardiopulmonary Conditions
- Associate Professor of Anesthesia
- Harvard Medical School
- Nancy Collop, MD
Nancy Collop, MD
- Editor-in-Chief — Sleep Medicine
- Section Editor — Sleep Related Breathing Disorders
- Professor of Medicine and Neurology
- Director, Emory Sleep Center, Emory University
- Deputy Editors
- Marianna Crowley, MD
Marianna Crowley, MD
- Deputy Editor — Anesthesiology
- Assistant Professor of Anesthesiology
- Harvard Medical School
- Geraldine Finlay, MD
Geraldine Finlay, MD
- Deputy Editor — Pulmonary, Critical Care, and Sleep Medicine
- Associate Professor
- Tufts University School of Medicine
Obstructive sleep apnea (OSA) is a disorder characterized by repetitive episodes of apnea or reduced inspiratory airflow due to upper airway obstruction during sleep. OSA is the most common type of sleep-disordered breathing, with an estimated prevalence of 1 in 4 males and 1 in 10 females for mild OSA, and 1 in 9 males and 1 in 20 females for moderate OSA . Over half of patients with OSA who present for surgery are undiagnosed [2,3]. OSA has been increasing in prevalence over the last two decades , and the number of perioperative patients with OSA is likely to continue to increase in parallel with the increase in obesity [5-7].
The incidence of perioperative complications is greater in patients with OSA, leading the American Society of Anesthesiologists, the American Academy of Sleep Medicine, and others to develop clinical practice guidelines and protocols for the perioperative management of patients with OSA [5,8-14]. Recommendations include maintaining a high index of suspicion for OSA, careful use of medications, vigilant monitoring for upper airway obstruction, and an integrated team approach to perioperative management. There is little direct evidence that these precautions improve outcomes, so recommendations are generally based upon indirect evidence, clinical rationale, and expert opinion.
The postoperative management of patients with OSA is reviewed here. The preoperative evaluation and management and anesthesia management for patients with known or suspected OSA are reviewed separately. (See "Surgical risk and the preoperative evaluation and management of adults with obstructive sleep apnea" and "Intraoperative management of adults with obstructive sleep apnea".)
Many patients with OSA are obese; perioperative considerations specific to obesity are reviewed separately. (See "Preanesthesia medical evaluation of the obese patient" and "Anesthesia for the obese patient".)
Complications and general care in the post-anesthesia care unit (PACU) are discussed separately. (See "Overview of complications in adults admitted to the post-anesthesia care unit".)
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