Management of sleep apnea in adults

  • Frances ChungEmail author
  • Charles Imarengiaye
Refresher Course Outline Refresher Course 5


Sleep disordered breathing is increasingly being recognized in the surgical population. This morbidity modifies the anesthetic care of affected patients. It is therefore imperative for the anesthesiologist to demonstrate a firm understanding of the patients at risk and the pathogenesis of this disorder. This will enable the anesthesiologist to provide specific care in the perioperative period.


Obstructive Sleep Apnea Sleep Apnea Sleep Disorder Obstructive Sleep Apnea Syndrome Respir Crit 
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  1. 1.
    Strollo PJ, Rogers RM. Obstructive sleep apnea. N Engl J Med 1996; 334: 99–104.PubMedCrossRefGoogle Scholar
  2. 2.
    Anonymous. Indications and standards for use of nasal continuous positive pressure (CPAP) in sleep apnea syndrome. American Thoracic Society. Official statement adopted March 1944. Am J Respir Crit Care Med 1994; 150: 1738–45.Google Scholar
  3. 3.
    Boushra NN. Anaesthetic management of patients with sleep apnea syndrome. Can J Anaesth 1996; 43: 599–616.PubMedGoogle Scholar
  4. 4.
    Toung T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328: 1230–5.CrossRefGoogle Scholar
  5. 5.
    Toung T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle aged men and women. Sleep 1997; 20: 705–6.Google Scholar
  6. 6.
    Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999; 131: 485–91.PubMedGoogle Scholar
  7. 7.
    Levinson PD, McGarvey ST, Carlisle CC, Eveloff SE, Herbert PN, Millman RP. Adiposity and cardiovascular risk factors for in men with obstructive sleep apnea. Chest 1993; 103: 1336–42.PubMedCrossRefGoogle Scholar
  8. 8.
    Davies RJO, Strailing J. The relationship between neck circumference, radiographic pharyngeal anatomy and the obstructive sleep apnea syndrome. Eur Resp J 1990; 3: 509–14.Google Scholar
  9. 9.
    Dealberto MJ, Ferber C, Garma L, Lemoine P, Alperovich A. Factors related to sleep apnea syndrome in sleep clinic patients. Chest 1994; 105: 1753–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Rajala R, Partinen M, Sane T, Pelkonen R, Huikuri K, Seppalainen AM. Obstructive sleep apnea syndrome in morbidly obese patients. J Intern Med 1991; 230: 125–9.PubMedGoogle Scholar
  11. 11.
    Stradling JR, Crosby JH. Predictors and prevalence of obstructive apnea and snoring in 1001 middle aged men. Thorax 1991; 46: 84–90.Google Scholar
  12. 12.
    Mortimore IL, Marshall I, Wraith PK, Sellar RJ, Douglas NJ. Neck and total body fat deposition in obese and non-obese patients with sleep apnea compared with that in control subjects. Am J Respir Crit Care Med 1998; 157: 280–3.PubMedGoogle Scholar
  13. 13.
    Bliwise DL, Feldman DE, Bliwise NG, et al. Risk factors for sleep disordered breathing in heterogenous geriatric population. J Am Geriatr Soc 1987; 13: 845–50.Google Scholar
  14. 14.
    Strohl KP, Redline S. Recognition of obstructive sleep apnea. Am J Respir Crit Care Med 1996; 154: 279–8.PubMedGoogle Scholar
  15. 15.
    Redline S, Kump K, Tishler PV, Browner I, Ferrette V. Gender differences in sleep disordered breathing in a community-based sample. Am J Respir Crit Care Med 1994; 149: 722–6.PubMedGoogle Scholar
  16. 16.
    Marin JM, Gascon JM, Carrizo S, Gispert J. Prevalence of sleep apnea syndrome inn the Spanish adult population. Int J Epidemiol 1997; 26: 381–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Walker RP, Durazo-Arvizu R, Wächter B, Gopalsami C. Preoperative differences between male and female patients with sleep apnea. Laryngoscope 2001; 111: 1501–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Dexter DD, Dovre EJ. Obstructive sleep apnea due to endogenous testosterone production in a woman. Mayo Clin Proc 1998; 73: 246–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Cistulli PA, Grunstein RR, Sullivan CE. Am J Resp Crit Care Med 1994; 149: 530–2.PubMedGoogle Scholar
  20. 20.
    Fogel RB, Malhotra A, Pittman SD, Dunaif A, White DP. Increased prevalence of obstructive sleep apnea syndrome in obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 2001; 86: 1175–80.Google Scholar
  21. 21.
    Ware JC, McBrayer RH, Scott JA. Influence of sex and age on duration and frequency of sleep apnea events. Sleep 2000; 23: 165–70.PubMedGoogle Scholar
  22. 22.
    O’Connor C, Thornley S, Hanly P. Gender differences in the polysomnagraphic features of obstructive sleep apnea. Am J Crit Care Med 2000; 161: 1465–72.Google Scholar
  23. 23.
    Remmers JE, DeGroot WJ, Sauerland EK, Anch AM. Pathogenesis of upper airway occlusion during sleep. J Appl Physiol 1978; 44: 931–8.PubMedGoogle Scholar
  24. 24.
    Strohl KP, Hensley MJ, Hallet M, Saunders NA, Ingram RH. Activation of upper airway muscles before onset of inspiration in normal humans. J Appl P 1980; 49: 638–42.Google Scholar
  25. 25.
    Hoffstein V, Zamel N. Sleep apnea and the upper airway. Br J Anaesth 1990; 65: 139–50.PubMedCrossRefGoogle Scholar
  26. 26.
    Issa EG, Edwards P, Szeto E, Lauff D, Sullivan C. Genioglossus and breathing responses to airway occlusion: effect of sleep and route of occlusion J Appl Physiol 1988; 64: 543–9.PubMedGoogle Scholar
  27. 27.
    Hudgel DW, Martin RJ, Johnson B, Hill P. Mechanics of the respiratory system and breathing pattern during sleep in normal humans. J Appl Physiol 1984; 56: 133–7.PubMedGoogle Scholar
  28. 28.
    Wiegand LC. Genioglossus muscle activity in normal men during wakefulness and sleep. J Appl Physiol 1990; 69: 1262–9.PubMedGoogle Scholar
  29. 29.
    Tangel DJ, Mezzanotte WS, White DP. Influence of sleep on tensor palatini EMG and upper airway resistance in normal men. J Appl Physiol 1991; 70: 2574–81.PubMedGoogle Scholar
  30. 30.
    Tangel DJ, Mezzanotte WS, Sandberg EJ, White DP. Influences of NREM sleep on the activity of tonic vs. inspiratory phasic muscles in normal men. J Appl Physiol 1992; 73: 1058–66.PubMedGoogle Scholar
  31. 31.
    Gleeson K, Zwillich CW, Braier K, White DP. Breathing route during sleep. Am Rev Respir Dis 1986; 134: 115–20.PubMedGoogle Scholar
  32. 32.
    Kuna ST, Sant’Ambragio G. Pathophysiology of upper airway closure during sleep. JAMA 1991; 266: 1384–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Issa EG, Sullivan CE. Upper airway closing pressures in obstructive sleep apnea. J Appl Physiol 1984; 57: 520–7.PubMedGoogle Scholar
  34. 34.
    White DP, Lombard RM, Cadieux RJ, Zwillich CW. Pharyngeal resistance in normal humans: influence of gender, age and obesity. J Appl Physiol 1985; 58: 365–71.PubMedGoogle Scholar
  35. 35.
    Brown IG, Zamel N, Hoffstein V. Pharyngeal cross-sectional area in normal men and women. J Appl Physiol 1986; 61: 890–5.PubMedGoogle Scholar
  36. 36.
    Sakakibura H, Tong M, Matsushita K, Hirata M, Konishi T, Suetsugu S. Cephalometric abnormalities in non-obese and obese patients with obstructive sleep apnea. Eur J Resp 1999; 13: 154–62.Google Scholar
  37. 37.
    Cistulli PA, Goptsopoulos H, Sullivan CE. Relationship between craniofacial abnormalities and sleep disordered breathing in Marian’s syndrome. Chest 2001; 120: 1455–60.PubMedCrossRefGoogle Scholar
  38. 38.
    McNicholas WE, Coffey M, McDonnell, O’Regan R, Fitzgerald MX. Upper airway obstruction during sleep in normal subjects after selective topical oropharyngeal anesthesia. Am Rev Respir Dis 1987; 135: 1316–19.PubMedGoogle Scholar
  39. 39.
    Deegan PC, McNicholas WE. Pathophysiology of obstructive sleep apnea. Eur Respir J 1995; 8: 1161–78.PubMedCrossRefGoogle Scholar
  40. 40.
    Remmers JE. Anatomy and physiology of upper airway obstruction. In: Kryger MH, Roth T, Dement WC, (Eds.). Principle and Practice of Sleep Medicine. Philadelphia PA: WB Saunders Co, 1989: 525–36.Google Scholar
  41. 41.
    Hiremath AS, Hillman DR, James AL, Noffsinger WJ, Platt PR, Singer SL. Relationship between difficult tracheal intubation and obstructive sleep apnea. Br J Anaesth 1998; 80: 606–11.PubMedGoogle Scholar
  42. 42.
    Benumof JL. Obstructive sleep apnea in the adult obese patient: implications for airway management. J Clin Anesth 2001; 13: 144–56.PubMedCrossRefGoogle Scholar
  43. 43.
    Chung F, Crago RR. Sleep apnoea syndrome and anaesthesia. Can Anaesth Soc J 1982; 29: 439–45.PubMedCrossRefGoogle Scholar
  44. 44.
    Entwistle MD, Roe PG, Sapsford DJ, Berrisford RG, Jones JG. Patterns of oxygenation after thoracotomy. Br J Anaesth 1991; 67: 704–11.PubMedCrossRefGoogle Scholar
  45. 45.
    Knudson J. Duration of hypoxaemia after uncomplicated upper abdominal and thoraco-abdominal operations. Anaesthesia 1970; 25: 372–7.CrossRefGoogle Scholar
  46. 46.
    Burgess LP, Derderian SS, Morin GV, Gonzalez C, Zajtchuk JT. Postoperative risk following uvulopalatopharyngoplasty for obstructive sleep apnea. Otolaryngol Head Neck Surg 1992; 106: 81–6.PubMedGoogle Scholar
  47. 47.
    McColley SA, April MM, Carroll JL, Naclerio RM, Loughlin GM. Respiratory compromise after adenotonsillectomy in children with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 1992; 118: 940–3.PubMedGoogle Scholar
  48. 48.
    Loadsman JA, Hillman DR. Anesthesia and sleep apnea. Br J Anaesth 2001; 86: 254–66.PubMedCrossRefGoogle Scholar
  49. 49.
    Hanning CD. Obstructive sleep apnea. Br J Anaesth 1989; 63: 477–88.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2002

Authors and Affiliations

  1. 1.Department of Anesthesia, Toronto Western HospitalUniversity Health Network, University of TorontoTorontoCanada

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