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Postoperative management of adults with obstructive sleep apnea

Eric Olson, MD
Frances Chung, MBBS, FRCPC
Edwin Seet, MBBS, MMed
Section Editors
Stephanie B Jones, MD
Nancy Collop, MD
Deputy Editors
Marianna Crowley, MD
Geraldine Finlay, MD


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 [1]. 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 [4], 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 post-anesthetic care for adult patients".)

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Literature review current through: Nov 2017. | This topic last updated: Apr 13, 2016.
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