J Clin Outcomes Manage
Perioperative screening for the management of patients with obstructive sleep apnea
Sundar E, Chang J, Smetana GW
Abstract: Objective: To provide a comprehensive review of studies related to screening for and perioperative management of patients with possible obstructive sleep apnea (OSA). Methods: We conducted a MEDLINE search for publications related to the incidence and morbidity of OSA, screening for OSA in perioperative patients, effects of anesthesia on OSA and the anesthetic management of patients with OSA. A manual search of bibliographies was undertaken. Results: Anesthesia and surgery are associated with loss of rapid eye movement (REM) sleep and subsequent rebound associated with exacerbation of OSA-related symptoms. Narcotic analgesics, muscle relaxants, and cholinesterase inhibitors also exacerbate OSA. OSA confers higher rates of perioperative airway management difficulties and traditional postoperative pulmonary complications. Available screening tools are described. An algorithm for the postanesthetic management of screen-positive patients that reduces the need for continuous monitoring and continuous positive airway pressure (CPAP) application is proposed. Conclusion: OSA is an important risk factor for perioperative medical complications. While screening tools for OSA in the perioperative populations have methodological deficiencies including high rates of false-positives leading to heavy resource utilization, we recommend their use before major noncardiac surgery.
Clinical Review Article
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