Perioperative Management of Patients with Obstructive Sleep Apnea

This evaluation may be initiated in a preanesthesia clinic (if available) or by direct consultation from the operating surgeon to the anesthesiologist.

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.^‡‡‡

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.