Perioperative Management for the Patients with Obstructive Sleep Apnea

ABSTRACT

The prevalence of obstructive sleep apnea (OSA) is on the rise worldwide due to an increase in metabolic syndrome, obesity, and aging. Patients with OSA are at higher risk of perioperative complications than those without OSA; however, OSA is often not diagnosed before surgery. For patients diagnosed with OSA or who are judged to be at risk of OSA by various screening tools, safe preparation for respiratory depression or difficult airway is critical. Exaggerated respiratory depression often occurs in response to commonly used sedatives and analgesics, and there is a high risk of hypoxic events due to difficulty in maintaining the airway. Currently, there is insufficient training of health care providers to screen and diagnose patients with OSA, and several screening tools are incomplete. In addition, the guidelines for optimal monitoring and perioperative management of patients with OSA have not yet been clearly established. In the present work, the author aims to explain the latest findings useful to sleep physicians regarding the overall management, including pre-operative evaluation and preparation, intraoperative anesthetic management, and post-operative general care and analgesic strategies, of patients at risk of OSA.