Sleep apnea is an entity characterized by repetitive upper airway obstruction resulting in nocturnal hypoxia and sleep fragmentation. It is estimated that 2%–4% of the middle-aged population has sleep apnea with a predilection in men relative to women. Risk factors of sleep apnea include obesity, gender, age, menopause, familial factors, craniofacial abnormalities, and alcohol. Sleep apnea has been increasingly recognized as a major health burden associated with hypertension and increased risk of cardiovascular disease and death. Increased airway collapsibility and derangement in ventilatory control responses are the major pathological features of this disorder. Polysomnography (PSG) is the gold-standard method for diagnosis of sleep apnea and assessment of sleep apnea severity; however, portable sleep monitoring has a diagnostic role in the setting of high pretest probability sleep apnea in the absence of significant comorbidity. Positive pressure therapy is the mainstay therapy of sleep apnea. Other treatment modalities, such as upper airway surgery or oral appliances, may be used for the treatment of sleep apnea in select cases. In this review, we focus on describing the sleep apnea definition, risk factor profile, underlying pathophysiologic mechanisms, associated adverse consequences, diagnostic modalities, and treatment strategies.

ClinicalTrials.gov; No.: NCT00607893; URL: www.clinicaltrials.gov.

Obstructive Sleep Apnea (OSA) has been associated with an increased risk of postoperative complications. The complication rate and length of hospital stay in patients with OSA undergoing lung resection has not specifically been evaluated. We postulate that OSA may be associated with an increased length of stay and risk of complications postlobectomy.Three hundred and twenty patients who underwent lobectomy between January 2009 and December 2011 were reviewed. Those with either a hospital coding of OSA, or medical history of OSA, were deemed as having OSA. Age, gender, a variety of preoperative co-morbidities, and lung function were used as covariates. Data analysis was performed using independent t-test/Kruskal-Wallis test for continuous variables, and the Chi square/ Fisher exact test for categorical variables. Multiple logistic regression method and linear regression were used to estimate the effect of OSA on complications and length of stay, controlling for the effects of potential confounders.Out of 320 patients, 25 carried the diagnostic code of OSA. The two groups were equivalent in regards to age, FEV1, DLCO and smoking status, but differed in Body Mass Index (BMI). Four out of the 25 patients with OSA developed post-lobectomy complications compared to 55 in the OSA negative group (16.0% vs. 18.6%, p-value>0.9). Length of stay in the OSA group was 4.16 ± 3.68 days compared to 4.32 ± 3.14 days in OSA negative group (p-value=0.639).After adjusting for comorbidities, OSA is not associated with an increase in complications or length of hospital stay following major lung resection.