10 September 2013

Obstructive Sleep Apnea When Having Surgery

If you suspect you have obstructive sleep apnea (OSA), and you are facing surgery, be sure to make this known to the anesthesiologist. This will alert this person to the possible complications you could develop from anesthesia. The following questions should give you some guidance to determine if you may have sleep apnea.

Answer the following questions truthfully. Remember that you will be the person suffering from anesthesia and unless you wish to spend time in the intensive care unit (ICU), it is wise to answer honestly and discuss this beforehand with the anesthesiologist. Going into an operation under anesthesia is a poor time to let vanity get the better of you.

#1. Do you snore loudly (loud enough to be heard through closed doors)?
#2. Are you often tired, fatigued, or sleepy during the daytime?
#3. Has anyone observed you stop breathing during your sleep?
#4. Do you have or are you being treated for high blood pressure?
#5. Is your body mass index > 35 kg/m2?
#6. Are you over 50 years old?
#7. Is your neck circumference > 40 cm?
#8. Are you male?

A person is considered to be at high risk for OSA if he or she answers yes to 5 or more of the 8 questions. This information has value beyond the benefits to anesthesia care. After being diagnosed with OSA, the patient can be referred to an internist or sleep physician to receive proper long-term treatment after the operation. Being a person with OSA myself, I know how important this is and I would not go back to my problems before sleep apnea treatment.

Having surgery done without knowledge of sleep apnea and in a hospital without an ICU may mean that you will not survive the operation. In the study, surgeons were not able to identify 90% of the patients with severe OSA. Anesthesiologists did not diagnose 53% of these patients. About one third of the patients with sleep study-identified OSA had only one or no cardinal symptoms of OSA. This indicates that these asymptomatic, "silent" patients are not going to be identified purely by history obtained by the physician.

One group of patients that is concerning to the anesthesiologist is surgical patients with undiagnosed OSA. Anesthesiologists also worry that such patients will be at higher recovery risk, especially when discharged home on opioids for pain. These patients may also have a higher incidence of difficult intubation, postoperative complications including delirium, increased admissions to the intensive care unit, and longer hospital stays.

If a patient is known to suffer from sleep apnea, then the anesthesiologist can be extra careful in properly managing opioids for pain relief and weighing other factors such as the risk for postoperative respiratory depression. This also opens the door for other combinations of analgesics or regional anesthesia to be considered. These patients warrant extra and longer monitoring in the recovery room. Initiation of continuous positive airway pressure (CPAP) perioperatively is also likely to be useful. A patient with undiagnosed OSA presenting for surgery would not receive such care if the diagnosis were unknown.

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