Chapter

Controversies in the Anesthetic Management of the Obese Surgical Patient

pp 103-110

Date:

Should all Morbidly Obese Patients be Evaluated for Obstructive Sleep Apnea?

  • Waleed RiadAffiliated withDepartment of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto
  • , Frances ChungAffiliated withDepartment of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto Email author 

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Abstract

Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repetitive episodes of apnea and hypopnea during sleep. There is a strong positive correlation between morbid obesity (MO) and OSA, with a prevalence of OSA in MO patients believed to be between 70 and 95%. It has been estimated that a body mass index (BMI) > 28 kg m−2 increases the possibility of moderate-to-severe OSA by fivefold. The gold standard for diagnosis of OSA is by polysomnography (PSG). However, it is a lengthy procedure and requires significant resources. In order to constrain cost and decrease the waiting time for diagnosis several portable sleep monitoring devices have been used successfully. Alternatively, there are screening questionnaires that are designed to classify patients based on history and physical examination in order to identify patients who need a formal sleep study. As each tool has its own limitation, this chapter will discuss in details all the possible options and the best way to accurately diagnose MO patients.