Obstructive sleep apnea (OSA) is a sleep disorder characterized by brief episodes of complete or partial airway obstruction during sleep, leading to recurrent awakening and reduced sleep quality. As the most common sleep-related respiratory disorder, obstructive sleep apnea affects as many as 1 billion people around the world (3). However, 80% of OSA patients remain undiagnosed, making it difficult for clinicians to accurately assess a patient’s level of risk for OSA when undergoing surgical procedures (2). Obstructive sleep apnea has been linked to several serious health problems, including cardiovascular disease, diabetes, and mental illness. In addition to its impacts on general health, obstructive sleep apnea can have a significant impact on anesthesia management during surgery, posing unique challenges for anesthesiologists and increasing the risk of adverse outcomes.
People living with obstructive sleep apnea experience fragmented, non-restorative sleep—and a variety of negative health effects due to the lack of sleep. For example, OSA patients may experience daytime sleepiness, fatigue, and impaired cognitive function, all of which can have a significant impact on their quality of life (2). Research has also demonstrated that obstructive sleep apnea has a strong association with cardiovascular complications such as hypertension, coronary artery disease, and heart failure, suggesting that OSA may increase a person’s risk of cardiovascular disease (6). The intermittent hypoxia and hypercapnia that occur during sleep can lead to the development of hypertension and atherosclerosis, increasing the risk of heart attack and stroke (4).
Obstructive sleep apnea impacts both general health and specifically outcomes during anesthesia and surgery. It increases a patient’s risk of complications during the perioperative period (3). Analgesic drugs used for anesthesia can deteriorate central respiratory activity and increase upper airway collapsibility (1). As a result, patients with obstructive sleep apnea experience a higher risk of respiratory complications during anesthesia. Drugs like opioids, neuromuscular blocking agents, and propofol can increase OSA patients’ risk of hypoxemia and respiratory failure (3). Furthermore, the airway obstruction that occurs during sleep for OSA patients can also occur during anesthesia induction, leading to difficulty in intubation and ventilation (3).
Current scientific consensus suggests that regional anesthesia is a safer option for patients with obstructive sleep apnea than general anesthesia when possible (3). Regional anesthesia that blocks neural pathways only at the surgical site may prevent OSA patients from experiencing the potentially fatal upper airway effects of general anesthesia while providing effective pain management (3). Additionally, incorporating multimodal anesthesia to coordinate the complementary effects of various analgesics appears to be a safe way to lower the risk of perioperative complications in OSA patients (1).
A multidisciplinary team of providers should be involved with the management of obstructive sleep apnea, considering that the disorder affects many aspects of a patient’s physical and mental health, with additional consideration for procedures requiring anesthesia (4). Early identification and appropriate management of obstructive sleep apnea can improve patient outcomes and reduce the risk of adverse events during anesthesia. The STOP-BANG questionnaire is commonly used to screen patients for obstructive sleep apnea prior to a surgical procedure since most OSA cases are undiagnosed (5). Patients with obstructive sleep apnea may be able to safely receive ambulatory and regular surgical procedures, given that providers accurately assess their risk and provide multidisciplinary, perioperative and postoperative care. Furthermore, healthcare providers should educate patients with OSA about the importance of lifestyle modifications and the use of CPAP machines to improve their quality of life and reduce the risk of respiratory complications.
References
- Cozowicz, Crispiana, and Stavros G Memtsoudis. “Perioperative Management of the Patient With Obstructive Sleep Apnea: A Narrative Review.” Anesthesia and analgesia vol. 132,5 (2021): 1231-1243. doi:10.1213/ANE.0000000000005444
- Faria, Andre et al. “The public health burden of obstructive sleep apnea.” Sleep science (Sao Paulo, Brazil) vol. 14,3 (2021): 257-265. doi:10.5935/1984-0063.20200111
- Memtsoudis, Stavros G et al. “Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea.” Anesthesia and analgesia vol. 127,4 (2018): 967-987. doi:10.1213/ANE.0000000000003434
- Slowik, Jennifer M., et al. “Obstructive Sleep Apnea.” StatPearls, StatPearls Publishing, 11 December 2022.
- Urman, Richard D et al. “Obstructive Sleep Apnea and Ambulatory Surgery: Who Is Truly at Risk?.” Anesthesia and analgesia vol. 129,2 (2019): 327-329. doi:10.1213/ANE.0000000000004217
- Yeghiazarians, Yerem et al. “Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association.” Circulation vol. 144,3 (2021): e56-e67. doi:10.1161/CIR.0000000000000988
