Obstructive sleep apnea syndrome: Anesthetic implications in the cardiac surgical patient

Abstract

PATIENTS with obstructive sleep apnea syndrome (OSAS) are characterized by excessive daytime sleepiness, snoring, and fragmentation of nighttime sleep. They are usually obese and have upper airway edema. The prevalence of sleep apnea syndrome among the general population is 1% to 4%, 1 Young T Palta M Dempsey J et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993; 328: 1230-1235 Crossref PubMed Scopus (8385) Google Scholar but in patients with ischemic heart disease (IHD), it has been reported in 30%. 2 Mooe T Rabben T Wiklund U et al. Sleep-disordered breathing in men with coronary artery disease. Chest. 1996; 109: 659-663 Crossref PubMed Scopus (310) Google Scholar A study by Maekawa et al 3 Maekawa M Shiomi T Usui K et al. Prevalence of ischaemic heart disease among patients with sleep apnea syndrome. Psychiatry Clin Neurosci. 1998; 52: 219-220 Crossref PubMed Scopus (20) Google Scholar found that IHD was seen as a complication in about one quarter of sleep apnea syndrome patients. Sleep apnea syndrome aggravates coronary risk factors promoting IHD 3 Maekawa M Shiomi T Usui K et al. Prevalence of ischaemic heart disease among patients with sleep apnea syndrome. Psychiatry Clin Neurosci. 1998; 52: 219-220 Crossref PubMed Scopus (20) Google Scholar and causes coronary spasm. 4 Akasaka K Akiba Y Ishii Y et al. Association between sleep apnea syndrome and coronary artery disease. Nippon Kyobu Shikkan Gakkai Zasshi. 1997; 35: 16-21 PubMed Google Scholar Abnormal breathing patterns during sleep have been reported to trigger cardiac arrhythmias. 5 Dark D Pingleton S Kerby G et al. Breathing pattern abnormalities and arterial oxygen desaturation during sleep in the congestive heart failure syndrome. Chest. 1987; 91: 833-836 Crossref PubMed Scopus (108) Google Scholar