Obstructive Sleep Apnea and the Adult Perioperative Patient

Abstract

Obstructive sleep apnea (OSA) is a chronic condition of upper airway obstruction during sleep. It is associated with significant morbidity and mortality and increases the perioperative risks of surgical patients. Thus, it is essential that perianesthesia nurses understand how to identify and manage patients with known or suspected OSA. This continuing education article will review the pathophysiology of OSA, discuss the effects of anesthesia and opioids on the sleep architecture of the OSA patients, describe the effects of OSA on postoperative complications, review the latest evidence on screening for undiagnosed OSA in the adult surgical patient, and review the perioperative management principles for patients with OSA.

Implementation Science: Incorporating Obstructive Sleep Apnea Screening and Capnography Into Everyday Practice

“…Patients who are most at risk for postoperative respiratory complications are the undiagnosed, high-risk OSA patient with BMIs >35 kg/m 2 , and one or more moderate-to-severe systemic diseases, as defined as ASA class > 2. 7,29 Results of this project highlight the importance of proactive, preoperative OSA screening to identify the vulnerable, high-risk OSA patient. With heightened awareness, the PACU RN along with interdisciplinary care team members, anticipate patient needs and work to avert adverse complications.…”

“…5e7 The OSA surgical patient is at risk for postoperative respiratory complications because of increased sensitivity to anesthetics and opioids that aggravate symptoms of hypoventilation and apnea that potentiate hypoxemia. 7,8 In one of the few published studies examining PACU respiratory events and OSA, Gali et al 9 found that patients at high risk for OSA and who had experienced recurrent respiratory events in the PACU were 13 times more likely to experience a postoperative complication. These complications are associated with an increase incidence of difficult intubation because of excess neck tissue, increased body mass index (BMI), and anatomical changes associated with OSA that contribute to a smaller oropharyngeal area to intubate.…”

“…10 Additional PACU complications include extended PACU length of stay, unplanned intensive care unit (ICU) admissions and respiratory and cardiovascular complications during the perioperative period. 7,9 Complications not only increase hospital expenses, where respiratory failure is the second most costly, but more importantly, lead to poor patient outcomes. 11…”

The influence of acute morphine use on obstructive sleep apnea: A systematic review and meta‐analysis

“…OSA is a global disease, and undiagnosed OSA is prevalent in anywhere between 21% and 28% of surgical patients (Chung et al, 2008; Finkel et al, 2009). This is important, as together with the effects of sedatives and anaesthetics on upper airway tone and respiratory drive, OSA increases perioperative risk (Lyons & Mokhlesi, 2014; Memtsoudis et al, 2018; Spence, Han, McGuire, & Couture, 2015). Accordingly, surgical patients with OSA are more likely to have adverse postoperative outcomes including intensive care unit transfer, respiratory failure, arrhythmia, and cardiac ischaemia (Gupta, Parvizi, Hanssen, & Gay, 2001; Kaw, Chung, et al, 2012; Kaw, Pasupuleti, Walker, Ramaswamy, & Foldvary‐Schafer, 2012; Mador et al, 2013; Paje & Kremer, 2006).…”

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“…Polysomnography is the gold standard for disease diagnosis. As well as polysomnography, physical examination, radiological diagnosis, and endoscopic diagnosis are also used [3]. Prevalence of coronary artery disease in patients with OSAS was found high.…”