Perioperative Management of Patients with Obstructive Sleep Apnea

Publication Date: February 1, 2014
Last Updated: March 14, 2022

Summary of Recommendations

Preoperative Evaluation

Anesthesiologists should work with surgeons to develop a protocol whereby patients in whom the possibility of obstructive sleep apnea (OSA) is suspected on clinical grounds are evaluated long enough before the day of surgery to allow preparation of a perioperative management plan.
  • This evaluation may be initiated in a preanesthesia clinic (if available) or by direct consultation from the operating surgeon to the anesthesiologist.

  • A preoperative evaluation should include a comprehensive review of previous medical records (if available), an interview with the patient and/or family, and conducting a physical examination.
  • Medical records review should include (but not be limited to) checking for a history of airway difficulty with previous anesthetics, hypertension, or other cardiovascular problems, and other congenital or acquired medical conditions.
  • Review of sleep studies is encouraged.

  • The patient and family interview should include focused questions related to snoring, apneic episodes, frequent arousals during sleep (e.g., vocalization, shifting position, and extremity movements), morning headaches, and daytime somnolence.‡‡‡

  • A physical examination should include an evaluation of the airway, nasopharyngeal characteristics, neck circumference, tonsil size, and tongue volume.
  • If any characteristics noted during the preoperative evaluation suggest that the patient has OSA, the anesthesiologist and surgeon should jointly decide whether to (1) manage the patient perioperatively based on clinical criteria alone or (2) obtain sleep studies, conduct a more extensive airway examination, and initiate indicated OSA treatment in advance of surgery.

  • If the preoperative evaluation does not occur until the day of surgery, the surgeon and anesthesiologist together may elect for presumptive management based on clinical criteria or a last-minute delay of surgery.

  • For safety, clinical criteria should be designed to have a high degree of sensitivity (despite the resulting low specificity), meaning that some patients may be treated more aggressively than would be necessary if a sleep study was available.

  • The severity of the patient’s OSA, the invasiveness of the diagnostic or therapeutic procedure, and the requirement for postoperative analgesics should be taken into account in determining whether a patient is at increased perioperative risk from OSA.

  • The patient and his or her family as well as the surgeon should be informed of the potential implications of OSA on the patient’s perioperative course.

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Overview

Title

Perioperative Management of Patients with Obstructive Sleep Apnea

Authoring Organization