Management of sleep apnea in adults

Abstract

PPER airway patency is essential for normal respiratory function. The maintenance of a patent airway is dependent on the pharyngeal and laryngeal structures. However, during speech, deglutition, regurgitation and eructation, the laryngeal and epiglottis do close momentarily. This is a protective mechanism that occurs during normal respiratory activities. The morphologic structure of the upper airway is important in the maintenance of the patent airway during sleep and wakefulness. The nasal passage has a bony architecture with the cartilaginous larynx and extrathoracic trachea, which helps produce a conduit for inspiration and expiration of air during sleep and wakeful state. However, in some individuals, there is a loss of this protective mechanism. In these individuals, obstruction to airflow does occur during sleep. The degree and extent of the obstruction and the ensuing clinical state is variable but critically dependent on the dilator muscles of the pharynx. The pharynx due to its characteristic structures remains a potential zone for the interruption of airflow. The three anatomic segments of the pharynx (nasopharynx, oropharynx, hypopharynx) have compliant structures, are liable to collapse resulting in obstruction to airflow during sleep (obstructive sleep apnea). The objective of this course therefore, is to provide a synopsis of the anesthetic management of this rather challenging clinical syndrome.

Patient selection in ambulatory anesthesia — An evidence-based review: part I

“…OSA patients are more likely to be difficult to intubate and emergency airway equipment should be readily available. 67 A recent retrospective study found 22% of OSA patients were difficult to intubate. 68 Several factors, including obesity, retrognathia and increased neck circumference contribute to the increased difficulty with intubation.…”

“…62,66,67 The type of surgery and need for postoperative narcotic analgesics are probably more important than the choice of anesthetic (grade D). Individual case-control study 4 Case-series Case-series Poor quality prognostic cohort study Poor quality cohort study Poor quality case-control study 5 Expert opinion without explicit critical Expert opinion without explicit critical appraisal, or appraisal, or based on physiology, bench based on physiology, bench research or research or "first principles" "first principles" CEBM = centre for evidence based medicine; RCT = randomized controlled trial; Case-control studies for prognosis should be considered poor quality prognostic cohorts or case series (Level 4 …”

Meeting the Challenge of Obstructive Sleep Apnea: Developing a Protocol That Guides Perianesthesia Patient Care

“…In the patient with OSA, episodes of apnea occur five or more times per hour of sleep, with an associated decrease in oxygen saturation (SaO 2 ) of more than 4%. 1 The patient with OSA may also have periods of hypopnea, a decrease in tidal volume. With these two factors common to the syndrome of OSA, the apnea-hypopnea index (AHI) is used to facilitate a diagnosis.…”

“…1 Apnea is the cessation of airflow. In the patient with OSA, episodes of apnea occur five or more times per hour of sleep, with an associated decrease in oxygen saturation (SaO 2 ) of more than 4%.…”

Respiratory and Cardiac Manifestations of Obstructive Sleep Apnea

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Obstructive sleep apnea hypopnea syndrome (OSAHS) is largely underdiagnosed in the general population, because as few as 20% of cases are symptomatic [1][2][3][4] and as many as 80% of all cases of OSAHS are unrecognized by primary care practitioners [1,[5][6][7]. OSAHS is estimated to affect 4% of men and 2% of women in Western countries, with a male to female ratio of 2 to 1 [8][9][10][11][12].

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