Preoperative screening and perioperative care of the patient with sleep-disordered breathing

Abstract

Emerging data are raising concerns that patients with known or suspected obstructive sleep apnea (OSA) are at increased risk for a myriad of perioperative complications. Strategies to identify patients preoperatively with OSA, or at risk for OSA, are being advocated. In addition, approaches to identify patients most at risk for OSA-related postoperative complications have been described. While lacking solid evidence, a number of perioperative management strategies have been proposed for the care of these patients. Recent studies utilizing different methodologies have provided additional evidence regarding the impact that OSA can have on postoperative outcomes, including increased risk of difficult intubations, adverse pulmonary outcomes, and delirium. Tools, such as the STOP-Bang questionnaire and limited channel monitoring, have been investigated with regards to their utility to identify not only patients at risk for OSA but also those at risk for more severe OSA. Consensus-based guidelines for the perioperative care of OSA patients have recently been published. OSA is quite common in patients presenting for elective surgery and has been linked to increased perioperative complications. Attempts to identify these patients preoperatively appear prudent. Protocols on how best to manage these patients are available, although validation of their effectiveness is needed.