Obstructive Sleep Apnea: Preoperative Screening and Postoperative Care.

Area of Science:

• Anesthesiology
• Sleep Medicine
• Critical Care Medicine

Background:

• Obstructive sleep apnea (OSA) is an epidemic condition frequently unrecognized in the perioperative setting.
• Undiagnosed OSA significantly contributes to perioperative morbidity and mortality, with hypoxic injury often misdiagnosed.
• Over 80% of patients with OSA undergoing elective surgery remain undiagnosed preoperatively.

Purpose of the Study:

• To highlight the prevalence and risks of undiagnosed obstructive sleep apnea in the perioperative period.
• To emphasize the importance of preoperative screening and postoperative management strategies for OSA patients.
• To advocate for interventions preventing perioperative apneic events and associated complications.

Main Methods:

• Review of the impact of sedatives, narcotics, general anesthesia, and postoperative changes on OSA patients.
• Discussion of preoperative screening tools like STOP or STOP-Bang questionnaires for adults.
• Recommendation for incorporating snoring questions in pediatric preoperative evaluations.

Main Results:

• The perioperative period exacerbates OSA risks due to anesthetic agents and altered sleep patterns.
• Preoperative screening can identify at-risk adult patients for obstructive sleep apnea.
• Known OSA patients require continued positive airway pressure therapy postoperatively.

Conclusions:

• Early identification of obstructive sleep apnea through preoperative screening is crucial.
• Continuous positive airway pressure (CPAP) should be maintained postoperatively for known OSA patients.
• Continuous pulse oximetry with alarms can prevent severe postoperative apneic events in OSA patients.