COMMENTARY

Obstructive Sleep Apnea in Surgical Patients

Alex Macario, MD, MBA

Disclosures

April 11, 2013

Viewpoint

One group of patients that is concerning to the anesthesiologist is surgical patients with undiagnosed OSA. Anesthesiologists worry that such patients will be at higher recovery risk, especially when discharged home on opioids for pain. These patients may also have a higher incidence of difficult intubation, postoperative complications including delirium, increased admissions to the intensive care unit, and longer hospital stays.

If a patient is known to suffer from sleep apnea, then the anesthesiologist can be extra careful in properly managing opioids for pain relief and weighing other factors such as the risk for postoperative respiratory depression. Furthermore, other combinations of analgesics or regional anesthesia can be considered. These patients warrant extra and longer monitoring in the recovery room. Initiation of continuous positive airway pressure perioperatively is also likely to be useful. A patient with undiagnosed OSA presenting for surgery would not receive such care if the diagnosis was unknown.

For these reasons, I was interested in the finding that almost one fifth of surgical patients have previously undiagnosed severe OSA. These patients were only diagnosed because they agreed to be enrolled in this study. As the investigators commented, the disparity between a high prevalence of undiagnosed OSA in the population and the low level of recognition and diagnosis at the time of preoperative consultation by surgeons and anesthesiologists is important.

It should be possible to reduce the proportion of undiagnosed severe OSA by implementing a formal screening tool as part of the routine preoperative anesthesia assessment. The results of screening can be used to determine whether a formal sleep study is indicated. In addition to the American Society of Anesthesiologists[1] practice guidelines, functional algorithms have been published that recommend preoperative screening.[2,3] This information has value beyond the benefits to anesthesia care. After being diagnosed with OSA, the patient can be referred to an internist or sleep physician to receive proper long-term treatment after the operation.

Abstract

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