Airway Management in Surgical Patients With Obstructive Sleep Apnea

Edwin Seet, MBBS, MMed, FAMS; Mahesh Nagappa, MD; David T. Wong, MD, FRCPC


Anesth Analg. 2021;132(5):1321-1327. 

In This Article

Patients With OSA and Surgery

Patients with OSA presenting for surgery can broadly fall into 2 main groups: (1) those that are scheduled for OSA-related upper airway surgery or (2) those scheduled for other surgeries unrelated to OSA. Examples of the former would include pharyngoplasty, palate surgery, tonsillectomy, epiglottis surgery, maxillofacial surgery, hyoid bone surgery, and upper airway stimulation, or a combination of these.[18] While non-OSA procedures in patients with OSA are broad-ranging, they are commonly found in surgical specialties that deal with obesity-related issues, such as bariatric procedures, joint arthroplasty, and liposuction surgery.

The preoperative assessment of the patient with OSA should involve the evaluation and optimization of concomitant comorbidities. These may comprise treatment-resistant hypertension, diabetes, heart failure, ischemic heart disease, metabolic syndrome, obesity, hypoventilation syndrome, and pulmonary hypertension, to name a few.[19–21] The American Society of Anesthesiologists, the American Academy of Sleep Medicine, the Society of Anesthesia and Sleep Medicine, the Canadian Anesthesiologists' Society, and others have developed clinical practice guidelines for the perioperative management of patients with OSA, with the goal of reducing perioperative complications.[19,21–24] A leading concern for the anesthesiologists is in managing the difficult airway in these patients with OSA. The eventual anesthesia modality is determined by anatomy, comorbidities, surgical requirements, opinions of the care team and, where flexibility exists, patient preference.