Understanding Phenotypes of Obstructive Sleep Apnea: Applications in Anesthesia, Surgery, and Perioperative Medicine

Abstract

Obstructive sleep apnea (OSA) is a prevalent sleep-disordered breathing with potential long-term major neurocognitive and cardiovascular sequelae. The pathophysiology of OSA varies between individuals and is composed of different underlying mechanisms. Several components including the upper airway anatomy, effectiveness of the upper airway dilator muscles such as the genioglossus, arousal threshold of the individual, and inherent stability of the respiratory control system determine the pathogenesis of OSA. Their recognition may have implications for the perioperative health care team. For example, OSA patients with a high arousal threshold are likely to be sensitive to sedatives and narcotics with a higher risk of respiratory arrest in the perioperative period. Supplemental oxygen therapy can help to stabilize breathing in OSA patients with inherent respiratory instability. Avoidance of supine position can minimize airway obstruction in patients with a predisposition to upper airway collapse in this posture. In this review, the clinically relevant endotypes and phenotypes of OSA are described. Continuous positive airway pressure (CPAP) therapy is the treatment of choice for most patients with OSA but tolerance and adherence can be a problem. Patient-centered individualized approaches to OSA management will be the focus of future research into developing potential treatment options that will help decrease the disease burden and improve treatment effectiveness.

Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses

“…OSA has many endotypes and phenotypes. 24 In patients with OSA, opioids attenuate the arousal response to hypoxia and prolongs airway obstruction. 25 26 The physiological phenotype of OSA with a high arousal threshold may be more sensitive to the sedative effects of opioids and anaesthetic drugs.…”

A Meta-analysis of Voxel-based Brain Morphometry Studies in Obstructive Sleep Apnea

“…As there is still no consensus regarding standardized diagnostic criteria for OSA, with AHI cut-off criteria considered an interim standard 101 , many researchers regard OSA as a heterogeneous disease in terms of symptoms, etiology, comorbidities and outcomes. At present, factors including AHI, EDS, sex, age, obesity and race/ethnicity are all recognized as phenotypes or important factors impacting OSA 102 , 103 . Our study demonstrated that these phenotypes based on clinical or demographic information had both significant (e.g., age and sex) and non-significant (e.g., AHI and ODI) relationships with GMV.…”

Association of Unrecognized Obstructive Sleep Apnea With Postoperative Cardiovascular Events in Patients Undergoing Major Noncardiac Surgery

“…bstructive sleep apnea (OSA) is the most common type of sleep-disordered breathing and is characterized by cyclical alterations between pharyngeal collapse and arousals during sleep. 1 Consequently, there are recurrent episodes of nocturnal hypoxemia, hypercapnia, endothelial dysfunction, hypercoagulability, and sympathetic overactivity. 2 In the general population, OSA is associated with higher risk of cardiovascular complications 3 such as hypertension, 4 myocardial ischemia, heart failure, 5 arrhythmias, stroke, 6 and sudden cardiac death.…”

“…7 General anesthetics, sedatives, and postoperative analgesics are potent respiratory depressants that relax the upper airway dilator muscles and impair ventilatory response to hypoxemia and hypercapnia. 1 Each of these events exacerbates OSA and may predispose patients to postoperative cardiovascular complications. In this respect, perioperative mismanagement of OSA has led to serious medicolegal consequences.…”