Perioperative care of patients with obstructive sleep apnea

It has been demonstrated that patients undergoing surgical procedures are at increased risk for complications if they have obstructive sleep apnea. It is believed that this increase in risk is related to more difficult intubations, use of ventilatory depressant medications, and perhaps body positioning. Although identifying patients with a preexisting diagnosis of sleep apnea is important so they can be triaged appropriately during the perioperative period, a bigger challenge is trying to identify patients who require a surgical procedure and may have undiagnosed sleep apnea. Hospitals and surgical centers should have policies in place to assist in such identification preoperatively, with a protocol on how to manage such patients perioperatively. Such guidelines exist, but many institutions do not have such protocols in place or fail to ensure that they are consistently followed. The key to the perioperative management is close observation of these high-risk patients. In ambulatory surgery populations, these patients should be observed for an extended period before being discharged to home. In inpatient settings, the observation can be tailored to the patient's postoperative risks based on the type of surgery and the severity of his or her sleep apnea. Patients undergoing bariatric surgery are at particularly high risk. These patients have a very high prevalence of sleep apnea and comorbid conditions. Screening this population for obstructive sleep apnea is mandatory, and a plan for postoperative observation should be in place in all institutions performing such surgery.