Sleep Apnea and the Perioperative Period: An Epidemic

Approximately 25 percent of American men and 10 percent of American women have obstructive sleep apnea (OSA). OSA causes several adverse effects, ranging from a simple loss of productivity to an increased risk of cardiopulmonary disease and sometimes related death.

OSA appears to increase perioperative complication risk, and patients who need or want surgical procedures of any type are more likely to have a diagnosis of OSA than those in the general population. With more than 40 million surgical procedures performed annually, that translates to a significant concern and an ongoing challenge for surgeons. Around 25 percent of surgical candidates may have OSA, and up to 80 percent of bariatric surgery candidates carry the diagnosis. But those figures may be low, as the majority of OSA cases are undiagnosed. Therefore, surgeons and hospitals are concerned about perioperative risk reduction for OSA patients.

When patients fail their surgeons’ OSA screening tools, many patients receive an initial indication that they may have the respiratory condition. Although those patients are then referred for workup and treatment, the surgeons must solve the dilemma of imminent surgery. Should surgery be canceled, delayed until OSA workup can be completed, or started right away?

In a “Perspectives” article in The New England Journal of Medicine, a team of anesthesiologists reviewed the current situation with attention to the American Society of Anesthesiologists’ 2012 guidelines for perioperative care of OSA patients. The guidelines suggest observing OSA patients for prolonged periods after surgery and prescribing routine positive airway pressure (PAP) intervention to reduce the risk of respiratory compromise that can occur as a result of surgical insults and respiratory-depressant drugs, including anesthetics and opioids. They also recommend postoperative pain management with non-opioid analgesic techniques.

The authors pointed out that the diagnosis and treatment of OSA is still in its infancy, and more research — especially on the perioperative period — is needed to clarify successful therapies and treatment durations. The researchers urged surgeons and institutions to stay abreast of the issue and develop policies and procedures for dealing with OSA patients, whether they are newly diagnosed or already receiving treatment.