Skip to main content
SpringerLink
Log in

Perioperative Care of Patients with Obstructive Sleep Apnea Syndrome

  • Chapter
  • First Online:
Essentials of Sleep Medicine

Part of the book series: Respiratory Medicine ((RM))

  • 1094 Accesses

Abstract

Obstructive sleep apnea (OSA) is a prevalent health condition in which anatomical factors lead to increased upper airway resistance causing repeated episodes of pharyngeal collapse and subsequent arousal from sleep. These apneic episodes result in hypoxemia and sympathetic nervous system activation. In the setting of anesthesia and postoperative analgesia, patients with OSA are at higher risk for increased frequency of disordered breathing events and cardiopulmonary complications. Several anesthesia and sleep societies have proposed guidelines for perioperative management of this patient population; however, the impact of the implementation of these recommended practices remains unclear.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Patil SP, Schneider H, Schwartz AR, Smith PL. Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest. 2007;132:325–37.

    Article  PubMed  Google Scholar 

  2. Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest. 1995;96:1897–904.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep a. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2014;120:268–86.

    Article  Google Scholar 

  4. Ayas NT, Laratta CR, Coleman JM, Doufas AG, Eikermann M, Gay PC, Gottlieb DJ, Gurubhagavatula I, Hillman DR, Kaw R, Malhotra A, Mokhlesi B, Morgenthaler TI, Parthasarathy S, Ramachandran SK, Strohl KP, Strollo PJ, Twery MJ, Zee PC, Chung FF, Sleep ATSAo, Respiratory N. Knowledge gaps in the perioperative management of adults with obstructive sleep apnea and obesity hypoventilation syndrome. An official American Thoracic Society workshop report. Ann Am Thorac Soc. 2018;15:117–26.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chung F, Memtsoudis SG, Ramachandran SK, Nagappa M, Opperer M, Cozowicz C, Patrawala S, Lam D, Kumar A, Joshi GP, Fleetham J, Ayas N, Collop N, Doufas AG, Eikermann M, Englesakis M, Gali B, Gay P, Hernandez AV, Kaw R, Kezirian EJ, Malhotra A, Mokhlesi B, Parthasarathy S, Stierer T, Wappler F, Hillman DR, Auckley D. Society of Anesthesia and Sleep Medicine Guidelines on preoperative screening and assessment of adult patients with obstructive sleep apnea. Anesth Analg. 2016;123:452–73.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Memtsoudis SG, Cozowicz C, Nagappa M, Wong J, Joshi GP, Wong DT, Doufas AG, Yilmaz M, Stein MH, Krajewski ML, Singh M, Pichler L, Ramachandran SK, Chung F. Society of Anesthesia and Sleep Medicine Guideline on intraoperative management of adult patients with obstructive sleep apnea. Anesth Analg. 2018;127:967–87.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Meoli AL, Rosen CL, Kristo D, Kohrman M, Gooneratne N, Aguillard RN, Fayle R, Troell R, Kramer R, Casey KR, Coleman J Jr, Clinical Practice Review C, American Academy of Sleep M. Upper airway management of the adult patient with obstructive sleep apnea in the perioperative period–avoiding complications. Sleep. 2003;26:1060–5.

    Article  PubMed  Google Scholar 

  8. Adesanya AO, Lee W, Greilich NB, Joshi GP. Perioperative management of obstructive sleep apnea. Chest. 2010;138:1489–98.

    Article  PubMed  Google Scholar 

  9. Young T, Palta M, Dempsey J, Peppard PE, Nieto FJ, Hla KM. Burden of sleep apnea: rationale, design, and major findings of the Wisconsin Sleep Cohort study. WMJ. 2009;108:246–9.

    PubMed  PubMed Central  Google Scholar 

  10. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177:1006–14.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Young 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.

    Article  CAS  PubMed  Google Scholar 

  12. Dempsey JA, Skatrud JB, Jacques AJ, Ewanowski SJ, Woodson BT, Hanson PR, Goodman B. Anatomic determinants of sleep-disordered breathing across the spectrum of clinical and nonclinical male subjects. Chest. 2002;122:840–51.

    Article  PubMed  Google Scholar 

  13. Li KK, Kushida C, Powell NB, Riley RW, Guilleminault C. Obstructive sleep apnea syndrome: a comparison between Far-East Asian and white men. Laryngoscope. 2000;110:1689–93.

    Article  CAS  PubMed  Google Scholar 

  14. Pranathiageswaran S, Badr MS, Severson R, Rowley JA. The influence of race on the severity of sleep disordered breathing. J Clin Sleep Med. 2013;9:303–9.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA. 2004;291:2013–6.

    Article  CAS  PubMed  Google Scholar 

  16. Young T, Peppard PE, Taheri S. Excess weight and sleep-disordered breathing. J Appl Physiol (1985). 2005;99:1592–9.

    Article  Google Scholar 

  17. Hales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL. Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007-2008 to 2015-2016. JAMA. 2018;319:1723–5.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lopez PP, Stefan B, Schulman CI, Byers PM. Prevalence of sleep apnea in morbidly obese patients who presented for weight loss surgery evaluation: more evidence for routine screening for obstructive sleep apnea before weight loss surgery. Am Surg. 2008;74:834–8.

    Article  PubMed  Google Scholar 

  19. Abdelsattar ZM, Hendren S, Wong SL, Campbell DA Jr, Ramachandran SK. The impact of untreated obstructive sleep apnea on cardiopulmonary complications in general and vascular surgery: a cohort study. Sleep. 2015;38:1205–10.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Mokhlesi B, Hovda MD, Vekhter B, Arora VM, Chung F, Meltzer DO. Sleep-disordered breathing and postoperative outcomes after bariatric surgery: analysis of the nationwide inpatient sample. Obes Surg. 2013;23:1842–51.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Memtsoudis SG, Stundner O, Rasul R, Chiu YL, Sun X, Ramachandran SK, Kaw R, Fleischut P, Mazumdar M. The impact of sleep apnea on postoperative utilization of resources and adverse outcomes. Anesth Analg. 2014;118:407–18.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Chan MTV, Wang CY, Seet E, Tam S, Lai HY, Chew EFF, Wu WKK, Cheng BCP, Lam CKM, Short TG, Hui DSC, Chung F. Postoperative vascular complications in unrecognized obstructive sleep apnea study I. Association of unrecognized obstructive sleep apnea with postoperative cardiovascular events in patients undergoing major noncardiac surgery. JAMA. 2019;321:1788–98.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Raveendran R, Wong J, Singh M, Wong DT, Chung F. Obesity hypoventilation syndrome, sleep apnea, overlap syndrome: perioperative management to prevent complications. Curr Opin Anaesthesiol. 2017;30:146–55.

    Article  CAS  PubMed  Google Scholar 

  24. Kaw R, Chung F, Pasupuleti V, Mehta J, Gay PC, Hernandez AV. Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome. Br J Anaesth. 2012;109:897–906.

    Article  CAS  PubMed  Google Scholar 

  25. Memtsoudis S, Liu SS, Ma Y, Chiu YL, Walz JM, Gaber-Baylis LK, Mazumdar M. Perioperative pulmonary outcomes in patients with sleep apnea after noncardiac surgery. Anesth Analg. 2011;112:113–21.

    Article  PubMed  Google Scholar 

  26. Opperer M, Cozowicz C, Bugada D, Mokhlesi B, Kaw R, Auckley D, Chung F, Memtsoudis SG. Does obstructive sleep apnea influence perioperative outcome? A qualitative systematic review for the Society of Anesthesia and Sleep Medicine Task Force on preoperative preparation of patients with sleep-disordered breathing. Anesth Analg. 2016;122:1321–34.

    Article  PubMed  Google Scholar 

  27. Lindenauer PK, Stefan MS, Johnson KG, Priya A, Pekow PS, Rothberg MB. Prevalence, treatment, and outcomes associated with OSA among patients hospitalized with pneumonia. Chest. 2014;145:1032–8.

    Article  PubMed  Google Scholar 

  28. Subramani Y, Nagappa M, Wong J, Patra J, Chung F. Death or near-death in patients with obstructive sleep apnoea: a compendium of case reports of critical complications. Br J Anaesth. 2017;119:885–99.

    Article  CAS  PubMed  Google Scholar 

  29. Kaw R, Bhateja P, Paz YMH, Hernandez AV, Ramaswamy A, Deshpande A, Aboussouan LS. Postoperative complications in patients with unrecognized obesity hypoventilation syndrome undergoing elective noncardiac surgery. Chest. 2016;149:84–91.

    Article  PubMed  Google Scholar 

  30. Hai F, Porhomayon J, Vermont L, Frydrych L, Jaoude P, El-Solh AA. Postoperative complications in patients with obstructive sleep apnea: a meta-analysis. J Clin Anesth. 2014;26:591–600.

    Article  PubMed  Google Scholar 

  31. D'Apuzzo MR, Browne JA. Obstructive sleep apnea as a risk factor for postoperative complications after revision joint arthroplasty. J Arthroplast. 2012;27:95–8.

    Article  Google Scholar 

  32. Masaracchia MM, Sites BD, Herrick MD, Liu H, Davis M. Association between sleep apnea and perioperative outcomes among patients undergoing shoulder arthroscopy. Can J Anaesth. 2018;65:1314–23.

    Article  PubMed  Google Scholar 

  33. Fiorentino M, Hwang F, Pentakota SR, Livingston DH, Mosenthal AC. Pulmonary complications in trauma patients with obstructive sleep apnea undergoing pelvic or lower limb operation. Trauma Surg Acute Care Open. 2020;5:e000529.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Golaz R, Tangel VE, Lui B, Albrecht E, Pryor KO, White RS. Post-operative outcomes and anesthesia type in total hip arthroplasty in patients with obstructive sleep apnea: a retrospective analysis of the State Inpatient Databases. J Clin Anesth. 2021;69:110159.

    Article  PubMed  Google Scholar 

  35. Gupta RM, Parvizi J, Hanssen AD, Gay PC. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study. Mayo Clin Proc. 2001;76:897–905.

    Article  CAS  PubMed  Google Scholar 

  36. Hiremath AS, Hillman DR, James AL, Noffsinger WJ, Platt PR, Singer SL. Relationship between difficult tracheal intubation and obstructive sleep apnoea. Br J Anaesth. 1998;80:606–11.

    Article  CAS  PubMed  Google Scholar 

  37. Siyam MA, Benhamou D. Difficult endotracheal intubation in patients with sleep apnea syndrome. Anesth Analg. 2002;95:1098–102, table of contents.

    Article  PubMed  Google Scholar 

  38. Rennotte MT, Baele P, Aubert G, Rodenstein DO. Nasal continuous positive airway pressure in the perioperative management of patients with obstructive sleep apnea submitted to surgery. Chest. 1995;107:367–74.

    Article  CAS  PubMed  Google Scholar 

  39. Mokhlesi B, Hovda MD, Vekhter B, Arora VM, Chung F, Meltzer DO. Sleep-disordered breathing and postoperative outcomes after elective surgery: analysis of the nationwide inpatient sample. Chest. 2013;144:903–14.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Mutter TC, Chateau D, Moffatt M, Ramsey C, Roos LL, Kryger M. A matched cohort study of postoperative outcomes in obstructive sleep apnea: could preoperative diagnosis and treatment prevent complications? Anesthesiology. 2014;121:707–18.

    Article  PubMed  Google Scholar 

  41. Karimi N, Kelava M, Kothari P, Zimmerman NM, Gillinov AM, Duncan AE. Patients at high risk for obstructive sleep apnea are at increased risk for atrial fibrillation after cardiac surgery: a cohort analysis. Anesth Analg. 2018;126:2025–31.

    Article  PubMed  Google Scholar 

  42. Ng KT, Lee ZX, Ang E, Teoh WY, Wang CY. Association of obstructive sleep apnea and postoperative cardiac complications: a systematic review and meta-analysis with trial sequential analysis. J Clin Anesth. 2020;62:109731.

    Article  PubMed  Google Scholar 

  43. Nagappa M, Ho G, Patra J, Wong J, Singh M, Kaw R, Cheng D, Chung F. Postoperative outcomes in obstructive sleep apnea patients undergoing cardiac surgery: a systematic review and meta-analysis of comparative studies. Anesth Analg. 2017;125:2030–7.

    Article  PubMed  Google Scholar 

  44. Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anaesth. 2010;57:423–38.

    Article  PubMed  Google Scholar 

  45. Ramachandran SK, Josephs LA. A meta-analysis of clinical screening tests for obstructive sleep apnea. Anesthesiology. 2009;110:928–39.

    Article  PubMed  Google Scholar 

  46. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108:812–21.

    Article  PubMed  Google Scholar 

  47. Seet E, Chua M, Liaw CM. High STOP-BANG questionnaire scores predict intraoperative and early postoperative adverse events. Singap Med J. 2015;56:212–6.

    Article  Google Scholar 

  48. Proczko MA, Stepaniak PS, de Quelerij M, van der Lely FH, Smulders JF, Kaska L, Soliman Hamad MA. STOP-Bang and the effect on patient outcome and length of hospital stay when patients are not using continuous positive airway pressure. J Anesth. 2014;28:891–7.

    Article  PubMed  PubMed Central  Google Scholar 

  49. 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.

    Article  CAS  PubMed  Google Scholar 

  50. Chung F, Ward B, Ho J, Yuan H, Kayumov L, Shapiro C. Preoperative identification of sleep apnea risk in elective surgical patients, using the Berlin questionnaire. J Clin Anesth. 2007;19:130–4.

    Article  PubMed  Google Scholar 

  51. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology. 2008;108:822–30.

    Article  PubMed  Google Scholar 

  52. Gross JB, Bachenberg KL, Benumof JL, Caplan RA, Connis RT, Cote CJ, Nickinovich DG, Prachand V, Ward DS, Weaver EM, Ydens L, Yu S, American Society of Anesthesiologists Task Force on Perioperative M. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2006;104:1081–93; quiz 1117-1088

    Article  PubMed  Google Scholar 

  53. Nagappa M, Liao P, Wong J, Auckley D, Ramachandran SK, Memtsoudis S, Mokhlesi B, Chung F. Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea among different populations: a systematic review and meta-analysis. PLoS One. 2015;10:e0143697.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Seguin L, Tamisier R, Deletombe B, Lopez M, Pepin JL, Payen JF. Preoperative screening for obstructive sleep apnea using alternative scoring models of the sleep tiredness observed pressure-body mass index age neck circumference gender questionnaire: an external validation. Anesth Analg. 2020;131:1025–31.

    Article  PubMed  Google Scholar 

  55. Kreitinger KY, Lui MMS, Owens RL, Schmickl CN, Grunvald E, Horgan S, Raphelson JR, Malhotra A. Screening for obstructive sleep apnea in a diverse bariatric surgery population. Obesity (Silver Spring). 2020;28:2028–34.

    Article  Google Scholar 

  56. Waseem R, Chan MTV, Wang CY, Seet E, Tam S, Loo SY, CKM L, Hui DS, Chung F. Diagnostic performance of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea in different ethnic groups. J Clin Sleep Med. 2020;17:521.

    Article  Google Scholar 

  57. Flemons WW, Whitelaw WA, Brant R, Remmers JE. Likelihood ratios for a sleep apnea clinical prediction rule. Am J Respir Crit Care Med. 1994;150:1279–85.

    Article  CAS  PubMed  Google Scholar 

  58. Gali B, Whalen FX Jr, Gay PC, Olson EJ, Schroeder DR, Plevak DJ, Morgenthaler TI. Management plan to reduce risks in perioperative care of patients with presumed obstructive sleep apnea syndrome. J Clin Sleep Med. 2007;3:582–8.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Gali B, Whalen FX, Schroeder DR, Gay PC, Plevak DJ. Identification of patients at risk for postoperative respiratory complications using a preoperative obstructive sleep apnea screening tool and postanesthesia care assessment. Anesthesiology. 2009;110:869–77.

    Article  PubMed  Google Scholar 

  60. Seet E, Chung F. Management of sleep apnea in adults – functional algorithms for the perioperative period: continuing professional development. Can J Anaesth. 2010;57:849–64.

    Article  PubMed  Google Scholar 

  61. Stierer TL, Wright C, George A, Thompson RE, Wu CL, Collop N. Risk assessment of obstructive sleep apnea in a population of patients undergoing ambulatory surgery. J Clin Sleep Med. 2010;6:467–72.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Nagappa M, Mokhlesi B, Wong J, Wong DT, Kaw R, Chung F. The effects of continuous positive airway pressure on postoperative outcomes in obstructive sleep apnea patients undergoing surgery: a systematic review and meta-analysis. Anesth Analg. 2015;120:1013–23.

    Article  PubMed  Google Scholar 

  63. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, Hagberg CA, Caplan RA, Benumof JL, Berry FA, Blitt CD, Bode RH, Cheney FW, Connis RT, Guidry OF, Nickinovich DG, Ovassapian A, American Society of Anesthesiologists Task Force on Management of the Difficult A. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118:251–70.

    Article  PubMed  Google Scholar 

  64. Acar HV, Yarkan Uysal H, Kaya A, Ceyhan A, Dikmen B. Does the STOP-Bang, an obstructive sleep apnea screening tool, predict difficult intubation? Eur Rev Med Pharmacol Sci. 2014;18:1869–74.

    CAS  PubMed  Google Scholar 

  65. Corso RM, Petrini F, Buccioli M, Nanni O, Carretta E, Trolio A, De Nuzzo D, Pigna A, Di Giacinto I, Agnoletti V, Gambale G. Clinical utility of preoperative screening with STOP-Bang questionnaire in elective surgery. Minerva Anestesiol. 2014;80:877–84.

    CAS  PubMed  Google Scholar 

  66. Gokay P, Tastan S, Orhan ME. Is there a difference between the STOP-BANG and the Berlin Obstructive Sleep Apnoea Syndrome questionnaires for determining respiratory complications during the perioperative period? J Clin Nurs. 2016;25:1238–52.

    Article  PubMed  Google Scholar 

  67. Kheterpal S, Han R, Tremper KK, Shanks A, Tait AR, O'Reilly M, Ludwig TA. Incidence and predictors of difficult and impossible mask ventilation. Anesthesiology. 2006;105:885–91.

    Article  PubMed  Google Scholar 

  68. Nagappa M, Wong DT, Cozowicz C, Ramachandran SK, Memtsoudis SG, Chung F. Is obstructive sleep apnea associated with difficult airway? Evidence from a systematic review and meta-analysis of prospective and retrospective cohort studies. PLoS One. 2018;13:e0204904.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Chung F, Yegneswaran B, Herrera F, Shenderey A, Shapiro CM. Patients with difficult intubation may need referral to sleep clinics. Anesth Analg. 2008;107:915–20.

    Article  PubMed  Google Scholar 

  70. Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia. 1984;39:1105–11.

    Article  CAS  PubMed  Google Scholar 

  71. Gentil B, de Larminat JM, Boucherez C, Lienhart A. Difficult intubation and obstructive sleep apnoea syndrome. Br J Anaesth. 1994;72:368.

    CAS  PubMed  Google Scholar 

  72. Kim JA, Lee JJ. Preoperative predictors of difficult intubation in patients with obstructive sleep apnea syndrome. Can J Anaesth. 2006;53:393–7.

    Article  CAS  PubMed  Google Scholar 

  73. Ezri T, Medalion B, Weisenberg M, Szmuk P, Warters RD, Charuzi I. Increased body mass index per se is not a predictor of difficult laryngoscopy. Can J Anaesth. 2003;50:179–83.

    Article  PubMed  Google Scholar 

  74. Mezzanotte WS, Tangel DJ, White DP. Waking genioglossal electromyogram in sleep apnea patients versus normal controls (a neuromuscular compensatory mechanism). J Clin Invest. 1992;89:1571–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  75. Eastwood PR, Platt PR, Shepherd K, Maddison K, Hillman DR. Collapsibility of the upper airway at different concentrations of propofol anesthesia. Anesthesiology. 2005;103:470–7.

    Article  CAS  PubMed  Google Scholar 

  76. Eastwood PR, Szollosi I, Platt PR, Hillman DR. Comparison of upper airway collapse during general anaesthesia and sleep. Lancet. 2002;359:1207–9.

    Article  PubMed  Google Scholar 

  77. Hillman DR, Chung F. Anaesthetic management of sleep-disordered breathing in adults. Respirology. 2017;22:230–9.

    Article  PubMed  Google Scholar 

  78. Dahan A, Teppema LJ. Influence of anaesthesia and analgesia on the control of breathing. Br J Anaesth. 2003;91:40–9.

    Article  CAS  PubMed  Google Scholar 

  79. Douglas NJ, White DP, Weil JV, Pickett CK, Zwillich CW. Hypercapnic ventilatory response in sleeping adults. Am Rev Respir Dis. 1982;126:758–62.

    CAS  PubMed  Google Scholar 

  80. Horner RL, Hughes SW, Malhotra A. State-dependent and reflex drives to the upper airway: basic physiology with clinical implications. J Appl Physiol (1985). 2014;116:325–36.

    Article  Google Scholar 

  81. Rehder K, Sessler AD, Marsh HM. General anesthesia and the lung. Am Rev Respir Dis. 1975;112:541–63.

    CAS  PubMed  Google Scholar 

  82. Ogunnaike BO, Jones SB, Jones DB, Provost D, Whitten CW. Anesthetic considerations for bariatric surgery. Anesth Analg. 2002;95:1793–805.

    Article  PubMed  Google Scholar 

  83. Memtsoudis SG, Stundner O, Rasul R, Sun X, Chiu YL, Fleischut P, Danninger T, Mazumdar M. Sleep apnea and total joint arthroplasty under various types of anesthesia: a population-based study of perioperative outcomes. Reg Anesth Pain Med. 2013;38:274–81.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Ambrosii T, Sandru S, Belii A. The prevalence of perioperative complications in patients with and without obstructive sleep apnoea: a prospective cohort study. Rom J Anaesth Intens Care. 2016;23:103–10.

    Google Scholar 

  85. Liu SS, Chisholm MF, Ngeow J, John RS, Shaw P, Ma Y, Memtsoudis SG. Postoperative hypoxemia in orthopedic patients with obstructive sleep apnea. HSS J. 2011;7:2–8.

    Article  PubMed  Google Scholar 

  86. Naqvi SY, Rabiei AH, Maltenfort MG, Restrepo C, Viscusi ER, Parvizi J, Rasouli MR. Perioperative complications in patients with sleep apnea undergoing total joint arthroplasty. J Arthroplast. 2017;32:2680–3.

    Article  Google Scholar 

  87. Vroegop AV, Vanderveken OM, Boudewyns AN, Scholman J, Saldien V, Wouters K, Braem MJ, Van de Heyning PH, Hamans E. Drug-induced sleep endoscopy in sleep-disordered breathing: report on 1,249 cases. Laryngoscope. 2014;124:797–802.

    Article  PubMed  Google Scholar 

  88. Lee CH, Mo JH, Kim BJ, Kong IG, Yoon IY, Chung S, Kim JH, Kim JW. Evaluation of soft palate changes using sleep videofluoroscopy in patients with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2009;135:168–72.

    Article  PubMed  Google Scholar 

  89. Boysen PG 2nd, Pappas MM, Evans B. An evidence-based opioid-free anesthetic technique to manage perioperative and periprocedural pain. Ochsner J. 2018;18:121–5.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Macintyre PE, Loadsman JA, Scott DA. Opioids, ventilation and acute pain management. Anaesth Intensive Care. 2011;39:545–58.

    Article  CAS  PubMed  Google Scholar 

  91. Etches RC. Respiratory depression associated with patient-controlled analgesia: a review of eight cases. Can J Anaesth. 1994;41:125–32.

    Article  CAS  PubMed  Google Scholar 

  92. Hagle ME, Lehr VT, Brubakken K, Shippee A. Respiratory depression in adult patients with intravenous patient-controlled analgesia. Orthop Nurs. 2004;23:18–27; quiz 28-19

    Article  PubMed  Google Scholar 

  93. Lam KK, Kunder S, Wong J, Doufas AG, Chung F. Obstructive sleep apnea, pain, and opioids: is the riddle solved? Curr Opin Anaesthesiol. 2016;29:134–40.

    Article  PubMed  Google Scholar 

  94. Bernards CM, Knowlton SL, Schmidt DF, DePaso WJ, Lee MK, McDonald SB, Bains OS. Respiratory and sleep effects of remifentanil in volunteers with moderate obstructive sleep apnea. Anesthesiology. 2009;110:41–9.

    Article  CAS  PubMed  Google Scholar 

  95. Pyati S, Gan TJ. Perioperative pain management. CNS Drugs. 2007;21:185–211.

    Article  CAS  PubMed  Google Scholar 

  96. White PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg. 2005;101:S5–22.

    Article  PubMed  Google Scholar 

  97. Joshi GP. Multimodal analgesia techniques for ambulatory surgery. Int Anesthesiol Clin. 2005;43:197–204.

    Article  PubMed  Google Scholar 

  98. Raghavendran S, Bagry H, Detheux G, Zhang X, Brouillette RT, Brown KA. An anesthetic management protocol to decrease respiratory complications after adenotonsillectomy in children with severe sleep apnea. Anesth Analg. 2010;110:1093–101.

    Article  PubMed  Google Scholar 

  99. Cavalcante AN, Sprung J, Schroeder DR, Weingarten TN. Multimodal analgesic therapy with gabapentin and its association with postoperative respiratory depression. Anesth Analg. 2017;125:141–6.

    Article  CAS  PubMed  Google Scholar 

  100. Lynn LA, Curry JP. Patterns of unexpected in-hospital deaths: a root cause analysis. Patient Saf Surg. 2011;5:3.

    Article  PubMed  PubMed Central  Google Scholar 

  101. Lee LA, Caplan RA, Stephens LS, Posner KL, Terman GW, Voepel-Lewis T, Domino KB. Postoperative opioid-induced respiratory depression: a closed claims analysis. Anesthesiology. 2015;122:659–65.

    Article  CAS  PubMed  Google Scholar 

  102. Bolden N, Posner KL, Domino KB, Auckley D, Benumof JL, Herway ST, Hillman D, Mincer SL, Overdyk F, Samuels DJ, Warner LL, Weingarten TN, Chung F. Postoperative critical events associated with obstructive sleep apnea: results from the Society of Anesthesia and Sleep Medicine Obstructive Sleep Apnea Registry. Anesth Analg. 2020;131:1032–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  103. Chan MT, Wang CY, Seet E, Tam S, Lai HY, Walker S, Short TG, Halliwell R, Chung F, Investigators P. Postoperative vascular complications in unrecognised Obstructive Sleep apnoea (POSA) study protocol: an observational cohort study in moderate-to-high risk patients undergoing non-cardiac surgery. BMJ Open. 2014;4:e004097.

    Article  PubMed  PubMed Central  Google Scholar 

  104. Lam T, Nagappa M, Wong J, Singh M, Wong D, Chung F. Continuous pulse oximetry and capnography monitoring for postoperative respiratory depression and adverse events: a systematic review and meta-analysis. Anesth Analg. 2017;125:2019–29.

    Article  PubMed  Google Scholar 

  105. Sanders MH, Kern NB, Costantino JP, Stiller RA, Strollo PJ Jr, Studnicki KA, Coates JA, Richards TJ. Accuracy of end-tidal and transcutaneous PCO2 monitoring during sleep. Chest. 1994;106:472–83.

    Article  CAS  PubMed  Google Scholar 

  106. Chung F, Wong J, Mestek ML, Niebel KH, Lichtenthal P. Characterization of respiratory compromise and the potential clinical utility of capnography in the post-anesthesia care unit: a blinded observational trial. J Clin Monit Comput. 2020;34:541–51.

    Article  PubMed  Google Scholar 

  107. Gay PC. Sleep and sleep-disordered breathing in the hospitalized patient. Respir Care. 2010;55:1240–54.

    PubMed  Google Scholar 

  108. Organized jointly by the American Thoracic Society tERStESoICM, the Societe de Reanimation de Langue F, approved by Ats Board of Directors D. International Consensus Conferences in Intensive Care Medicine: noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med. 2001;163:283–91.

    Article  Google Scholar 

  109. Liao P, Luo Q, Elsaid H, Kang W, Shapiro CM, Chung F. Perioperative auto-titrated continuous positive airway pressure treatment in surgical patients with obstructive sleep apnea: a randomized controlled trial. Anesthesiology. 2013;119:837–47.

    Article  PubMed  Google Scholar 

  110. Chung F, Liao P, Yegneswaran B, Shapiro CM, Kang W. Postoperative changes in sleep-disordered breathing and sleep architecture in patients with obstructive sleep apnea. Anesthesiology. 2014;120:287–98.

    Article  PubMed  Google Scholar 

  111. Hillman DR, Jungquist CR, Auckley D. Perioperative implementation of noninvasive positive airway pressure therapies. Respir Care. 2018;63:479–87.

    Article  PubMed  Google Scholar 

  112. Guralnick AS, Pant M, Minhaj M, Sweitzer BJ, Mokhlesi B. CPAP adherence in patients with newly diagnosed obstructive sleep apnea prior to elective surgery. J Clin Sleep Med. 2012;8:501–6.

    Article  PubMed  PubMed Central  Google Scholar 

  113. Fernandez-Bustamante A, Bartels K, Clavijo C, Scott BK, Kacmar R, Bullard K, Moss AFD, Henderson W, Juarez-Colunga E, Jameson L. Preoperatively screened obstructive sleep apnea is associated with worse postoperative outcomes than previously diagnosed obstructive sleep apnea. Anesth Analg. 2017;125:593–602.

    Article  CAS  PubMed  Google Scholar 

  114. Chung F, Nagappa M, Singh M, Mokhlesi B. CPAP in the perioperative setting: evidence of support. Chest. 2016;149:586–97.

    Article  PubMed  PubMed Central  Google Scholar 

  115. Meurgey JH, Brown R, Woroszyl-Chrusciel A, Steier J. Peri-operative treatment of sleep-disordered breathing and outcomes in bariatric patients. J Thorac Dis. 2018;10:S144–52.

    Article  PubMed  PubMed Central  Google Scholar 

  116. Ferreyra GP, Baussano I, Squadrone V, Richiardi L, Marchiaro G, Del Sorbo L, Mascia L, Merletti F, Ranieri VM. Continuous positive airway pressure for treatment of respiratory complications after abdominal surgery: a systematic review and meta-analysis. Ann Surg. 2008;247:617–26.

    Article  PubMed  Google Scholar 

  117. Zarbock A, Mueller E, Netzer S, Gabriel A, Feindt P, Kindgen-Milles D. Prophylactic nasal continuous positive airway pressure following cardiac surgery protects from postoperative pulmonary complications: a prospective, randomized, controlled trial in 500 patients. Chest. 2009;135:1252–9.

    Article  PubMed  Google Scholar 

  118. Squadrone V, Coha M, Cerutti E, Schellino MM, Biolino P, Occella P, Belloni G, Vilianis G, Fiore G, Cavallo F, Ranieri VM, Piedmont Intensive Care Units N. Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. JAMA. 2005;293:589–95.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA

    Kara L. Dupuy-McCauley

  2. Sleep Medicine, Mayo Clinic, Rochester, MN, USA

    Haven R. Malish

  3. Department of Medicine, Mayo Clinic, Rochester, MN, USA

    Peter C. Gay

Authors
  1. Kara L. Dupuy-McCauley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Haven R. Malish
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter C. Gay
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter C. Gay .

Editor information

Editors and Affiliations

  1. Department of Internal Medicine Wayne State University School of Medicine, John D. Dingell VA Medical Center, Detroit, MI, USA

    M. Safwan Badr

  2. Geriatric Research Education and Clinical Center, Veteran Affairs Greater Los Angeles Healthcare System, Department of Medicine David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Jennifer L. Martin

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Dupuy-McCauley, K.L., Malish, H.R., Gay, P.C. (2022). Perioperative Care of Patients with Obstructive Sleep Apnea Syndrome. In: Badr, M.S., Martin, J.L. (eds) Essentials of Sleep Medicine. Respiratory Medicine. Humana, Cham. https://doi.org/10.1007/978-3-030-93739-3_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-93739-3_10

  • Published:

  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-93738-6

  • Online ISBN: 978-3-030-93739-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation