Abstract
In some conditions continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BIPAP) therapy alone fails to provide satisfactory oxygenation. In these situations oxygen (O2) is often being added to CPAP/BIPAP mask or hose. Central sleep apnea and obstructive sleep apnea (OSA) are often present along with other chronic conditions, such as chronic obstructive pulmonary disease (COPD), congestive heart failure, pulmonary fibrosis, neuromuscular disorders, chronic narcotic use, or central hypoventilation syndrome. Any of these conditions may lead to the need for supplemental O2 administration during the titration process. Maximization of comfort, by delivering O2 directly via a nasal cannula through the mask, will provide better oxygenation and ultimately treat the patient with lower CPAP/BIPAP pressure.
Highlights
Obstructive sleep apnea (OSA) is a complex medical disorder, characterized by repetitive upper airway collapse during sleep
We set the bilevel positive airway pressure (BIPAP) machine to pressure of 8/4 cm H2O and were able to adjust the pressure to 12/6 cm H2O with SaO2 of 92% and adequate tidal volume
Patients with severe obstructive sleep apnea are at increased risk for respiratory and cardiopulmonary complications [5]
Summary
Obstructive sleep apnea (OSA) is a complex medical disorder, characterized by repetitive upper airway collapse during sleep. Perioperative apneas appear to be multifactorial in nature. Sedatives and anesthetics have been shown to decrease pharyngeal muscle tone and predispose to apnea [2]. The patient’s normal arousal responses and reflexes are compromised by anesthetics [3]. This predisposes to apneic episodes which can be more severe than those associated with natural sleep. While many patients present for surgery with undiagnosed OSA, it is currently recommended that patients who receive ambulatory CPAP preoperatively should continue to have CPAP administered in the perioperative period. The optimal management of OSA in the perioperative period has yet to be elucidated [4]
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