Perioperative Implications of Obstructive Sleep Apnea

Abstract

Obstructive sleep apnea (OSA) was first described by novelist Charles Dickens in The Posthumous Papers of the Pickwick Club, published in 1937. The character Joe was an obese boy who was constantly hungry, red in the face, and always falling asleep in the middle of his duties. Dickens [1] writes: The object that presented itself to the eyes of the astonished clerk was a boy—a wonderfully fat boy—habited as a serving lad, standing upright on the mat, with his eyes closed as if in sleep. ‘Sleep!’ said the old gentleman, ‘he’s always asleep. Goes on errands fast asleep, and snores as he waits at tables.’ ‘How very odd!’ said Mr Pickwick. ‘Ah! Odd indeed,’ returned the old gentleman; ‘I’m proud of that boy—wouldn’t part with him on any account—he’s a natural curiosity!’. OSA is a common cause of daytime sleepiness for millions of Americans. It is estimated that in adults between the ages of 30 and 60 years, 9% of women and 24% of men have OSA, whereas 2% of women and 4% of men have OSA with daytime sleepiness [2]. The prevalence of OSA increases with age [3]. OSA is associated with an increased incidence of hypertension [4], coronary artery disease [5,6], cardiovascular morbidity and mortality [7], cor pulmonale [8], stroke [9,10], neurocognitive dysfunction [11], motor vehicle accidents [12], and a decreased quality of life [13]. DEFINITION OF OSA OSA is clinically characterized by recurrent episodes of upper-airway obstruction that result in cessation (apnea) or reduction (hypopnea) in airflow during sleep, often accompanied by hypoxia and/or hypercarbia. The diagnosis of OSA is based on the apnea-hypopnea index (AHI), which is a count of the number of apneas and hypopneas per hour of sleep. Apnea is defined as the cessation of airflow for at least 10 seconds in the presence of thoracoabdominal ventilatory efforts and hypopnea as a 50% or more reduction in breathing