Abstract
Obstructive sleep apnoea syndrome (OSAS) is a rather common sleep disorder and constitutes a risk or an aggravating factor for various underlying diseases. OSAS is characterised by repeated upper airway collapse during sleep causing fragmented sleep, hypoxemia and hypercapnia. It may also cause considerable changes in intrathoracic pressure and an increase in sympathetic nervous activity, which represent the basis of associated pathologies such as arterial hypertension, ischaemic heart disease, diabetes mellitus, stroke and sudden death [1]. Moreover, there is a well-established association between OSAS and postoperative complications [2, 3]. Nevertheless, a significant proportion of patients affected by OSAS undergo surgery without diagnosis and, consequently, without therapy [4]. Therefore, it is crucial for the anaesthesiologist to identify patients at risk of OSAS before surgery for a correct definition of a perioperative strategy to reduce the risk of perioperative complication. This process should be done independently and regardless of whether the patient undergoes general or locoregional anaesthesia.
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References
Mehra R (2007) Sleep-disordered breathing and cardiovascular disease: exploring pathophysiology and existing data. Curr Resp Med Rev 3:258–269
Liao P, Yegneswaran B, Vairavanathan S et al (2009) Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study. Can J Anesth 56:819–828
Kaw R, Pasupuleti V, Walker E, Ramaswamy A, Foldvary-Schafer N (2012) Postoperative complications in patients with obstructive sleep apnea. Chest 141(2):436–441
Chung F, Ward B, Ho J et al (2007) Preoperative identification of sleep apnea risk in elective surgical patients using the Berlin questionnaire. J Clin Anesth 19:130–134
Linee guida di procedura diagnostica nella sindrome delle apnee ostruttive nel sonno dell’adulto. Commissione paritetica AIPO-AIMS (2001) Rassegna Pat App Respir 16:261–272
Regione Emilia Romagna (2008) Percorso diagnostico terapeutico. Sindrome delle apnee ostruttive del sonno. 25th June 2008
Iber C, Ancoli-Israel S, Cheeson A et al (2007) The AASM manual for the scoring of sleep and associated events, rules, terminology and technical specifications. American Academy of Sleep Medicine, Westchester
Qaseem A, Dallas P, Owens DK, Starkey M, Holty JE, Shekelle P, Clinical Guidelines Committee of the American College of Physicians (2014) Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med 161(3):210–220
Garg R, Singh A, Prasad R, Saheer S, Jabeed P, Verma R (2012) A comparative study on the clinical and polysomnographic pattern of obstructive sleep apnea among obese and non-obese subjects. Ann Thorac Med 7(1):26–30
Young T, Palta M, Dempsey J et al (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235
Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165:1217–1239
Ryan CM, Bradley TD (2005) Pathogenesis of obstructive sleep apnea. J Appl Physiol 99:2440–2450
Frey WC, Pilcher J (2003) Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg 13:676–683
Malow BA, Levy K, Maturen K et al (2000) Obstructive sleep apnea is common in medically refractory epilepsy patients. Neurology 55:1002–1007
Pollak L, Shpirer I, Rabey JM et al (2004) Polysomnography in patients with intracranial tumors before and after operation. Acta Neurol Scand 109:56–60
Fidan H, Fidan F, Unlu M, Ela Y, Ibis A, Tetik L (2006) Prevalence of sleep apnoea in patients undergoing operation. Sleep Breath 10:161–165
Lopez PP, Stefan B, Schulman CI et al (2008) Prevalence of sleep apnea in morbidly obese patients who presented for weight loss surgery evaluation: more evidence for routine screening for obstructive sleep apnea before weight loss surgery. Am Surg 74:834–838
O’Keeffe T, Patterson EJ (2004) Evidence supporting routine polysomnography before bariatric surgery. Obes Surg 14:23–26
Finkel KJ, Searleman AC, Tymkew H et al (2009) Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med 10(7):753–758
Singh M, Liao P, Kobah S, Wijeysundera DN, Shapiro C, Chung F (2013) Proportion of surgical patients with undiagnosed obstructive sleep apnoea. Br J Anaesth 110(4):629–636
Ayappa I, Rapoport DM (2003) The upper airway in sleep: physiology of the pharynx. Sleep Med Rev 7(1):9–33
Owens RL, Eckert DJ, Yim Yeh S et al (2008) Upper airway function in the pathogenesis of obstructive sleep apnea: a review of the current literature. Curr Opin Pulm Med 14:519–524
Dahan A, van den Elsen MJ, Berkenbosch A, DeGoede J, Olievier IC, van Kleef JW, Bovill JG (1994) Effects of subanesthetic halothane on the ventilatory responses to hypercapnia and acute hypoxia in healthy volunteers. Anesthesiology 80:727–738
Drummond GB (1995) Effects of extradural sufentanil and morphine on ventilation. Br J Anaesth 74:492–493
Eastwood PR, Platt PR, Shepherd K, Maddison K, Hillman DR (2005) Collapsibility of the upper airway at different concentrations of propofol anesthesia. Anesthesiology 103:470–477
Kaw R, Michota F, Jaffer A, Ghamande S, Auckley D, Golish J (2006) Unrecognized sleep apnea in the surgical patient: implications for the perioperative setting. Chest 129:198–205
Rosenberg J, Wildschiødtz G, Pedersen MH, von Jessen F, Kehlet H (1994) Late postoperative nocturnal episodic hypoxaemia and associated sleep pattern. Br J Anaesth 72(2):145–150
Ramachandran SK, Haider N, Saran KA, Mathis M, Kim J, Morris M, O’Reilly M (2011) Life-threatening critical respiratory events: a retrospective study of postoperative patients found unresponsive during analgesic therapy. J Clin Anesth 23(3):207–213
Gupta RM, Parvizi J, Hanssen AD et al (2001) Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case–control study. Mayo Clin Proc 76:897–905
Chung SA, Yuan H, Chung F (2008) A systemic review of obstructive sleep apnea and its implications for anesthesiologists. Anesth Analg 107:1543–1563
Gessler EM, Bondy PC (2003) Respiratory complications following tonsillectomy/UPPP: is step-down monitoring necessary? Ear Nose Throat J 82:628–632
Kim JA, Lee JJ, Jung HH (2005) Predictive factors of immediate postoperative complications after uvulopalatopharyngoplasty. Laryngoscope 115:1837–1840
Esclamado RM, Glenn MG, McCulloch TM et al (1989) Perioperative complications and risk factors in the surgical treatment of obstructive sleep apnea syndrome. Laryngoscope 99:1125–1129
Kaw R, Golish J, Ghamande S et al (2006) Incremental risk of obstructive sleep apnea on cardiac surgical outcomes. J Cardiovasc Surg 47(6):683–689
Memtsoudis S, Liu SS, Ma Y et al (2011) Perioperative pulmonary outcomes in patients with sleep apnea after noncardiac surgery. Anesth Analg 112(1):113–121
Flink BJ, Rivelli SK, Cox EA, White WD, Falcone G, Vail TP, Young CC, Bolognesi MP, Krystal AD, Trzepacz PT, Moon RE, Kwatra MM (2012) Obstructive sleep apnea and incidence of postoperative delirium after elective knee replacement in the nondemented elderly. Anesthesiology 116(4):788–796
Kaw R, Chung F, Pasupuleti V, Mehta J, Gay PC, Hernandez AV (2012) Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome. Br J Anaesth 109(6):897–906
Lockhart EM, Willingham MD, Abdallah AB, Helsten DL, Bedair BA, Thomas J, Duntley S, Avidan MS (2013) Obstructive sleep apnea screening and postoperative mortality in a large surgical cohort. Sleep Med 14(5):407–415
Mokhlesi B, Hovda MD, Vekhter B, Arora VM, Chung F, Meltzer DO (2013) Sleep-disordered breathing and postoperative outcomes after elective surgery: analysis of the nationwide inpatient sample. Chest 144(3):903–914
Mokhlesi B, Hovda MD, Vekhter B, Arora VM, Chung F, Meltzer DO (2013) Sleep-disordered breathing and postoperative outcomes after bariatric surgery: analysis of the nationwide inpatient sample. Obes Surg 23(11):1842–1851
Seet E, Chung F (2010) Management of sleep apnea in adults – functional algorithms for the perioperative period: continuing professional development. Can J Anaesth 57(9):849–864
Adesanya AO, Lee W, Greilich NB, Joshi GP (2010) Perioperative management of obstructive sleep apnea. Chest 138(6):1489–1498
Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea (2014) Anesthesiology 120(2):268–286
Documento Intersocietario: Raccomandazioni SIAARTI-AIMS per la gestione perioperatoria del paziente affetto da Sindrome delle Apnee Ostruttive del Sonno. http://www.siaarti.it/corsi-patrocini/linee-guida-raccomandazioni/
Chung F, Yegneswaran B, Liao P et al (2008) STOP Questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 108:812–821
Farney RJ, Walker BS, Farney RM, Snow GL, Walker JM (2011) The STOP-Bang equivalent model and prediction of severity of obstructive sleep apnea: relation to polysomnographic measurements of the apnea/hypopnea index. J Clin Sleep Med 7(5):459–465
Chung F, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y (2012) High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth 108(5):768–775
Corso RM, Petrini F, Buccioli M et al (2014) Clinical utility of preoperative screening with STOP-Bang questionnaire in elective surgery. Minerva Anestesiol 80(8):877–884
Memtsoudis SG, Stundner O, Rasul R, Sun X, Chiu YL, Fleischut P, Danninger T, Mazumdar M (2013) Sleep apnea and total joint arthroplasty under various types of anesthesia: a population-based study of perioperative outcomes. Reg Anesth Pain Med 38(4):274–281
Siyam MA, Benhamou D (2002) Difficult endotracheal intubation in patients with sleep apnea syndrome. Anesth Analg 95:1098–1102
Kim JA, Lee JJ (2006) Preoperative predictors of difficult intubation in patients with obstructive sleep apnea syndrome. Can J Anaesth 53:393–397
Corso RM, Piraccini E, Calli M et al (2011) Obstructive sleep apnea is a risk factor for difficult endotracheal intubation. Minerva Anestesiol 77(1):99–100
Kheterpal S, Martin L, Shanks AM, Tremper KK (2009) Prediction and outcomes of impossible mask ventilation: a review of 50,000 anesthetics. Anesthesiology 110:891–897
Cattano D, Killoran PV, Cai C, Katsiampoura AD, Corso RM, Hagberg CA (2014) Difficult mask ventilation in general surgical population: observation of risk factors and predictors. F1000Res 3:204
Plunkett AR, McLean BC, Brooks D et al (2011) Does difficult mask ventilation predict obstructive sleep apnea? A prospective pilot study to identify the prevalence of osa in patients with difficult mask ventilation under general anesthesia. J Clin Sleep Med 7(5):473–477
Gruppo di Studio SIAARTI “Vie Aeree Difficili”; IRC e SARNePI; Task Force (2005) Recommendations for airway control and difficult airway management. Minerva Anestesiol 71:617–657
Waugh JB, Epps CA, Khodneva YA (2011) Capnography enhances surveillance of respiratory events during procedural sedation: a meta-analysis. J Clin Anesth 23(3):189–196
Murphy GS, Brull SJ (2010) Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Anesth Analg 111(1):120–128
Burns SM, Egloff MB, Ryan B et al (1994) Effect of body position on spontaneous respiratory rate and tidal volume in patients with obesity, abdominal distension and ascites. Am J Crit Care 3:102–106
Cavallone LF, Vannucci A (2013) Review article: extubation of the difficult airway and extubation failure. Anesth Analg 116(2):368–383
Etches RC (1994) Respiratory depression associated with patient controlled analgesia: a review of eight cases. Can J Anaesth 41:125–132
Cullen DJ (2001) Obstructive sleep apnea and postoperative analgesia: a potentially dangerous combination. J Clin Anesth 13:83–85
Savoia G et al (2010) Postoperative pain treatment SIAARTI recommendations. Minerva Anestesiol 76(8):657–667
Loadsman JA, Hillman DR (2001) Anaesthesia and sleep apnea. Br J Anaesth 86(2):254–266
Neill AM, Angus SM, Sajkov D et al (1997) Effects of sleep posture on upper airway stability in patients with obstructive sleep apnea. Am J Respir Crit Care Med 155:199–204
Rennotte MT, Baele P, Aubert G et al (1995) Nasal continuous positive airway pressure in the perioperative management of patients with obstructive sleep apnea submitted to surgery. Chest 107:367–374
Mutter TC, Chateau D, Moffatt M, Ramsey C, Roos LL, Kryger M (2014) A matched cohort study of postoperative outcomes in obstructive sleep apnea: could preoperative diagnosis and treatment prevent complications? Anesthesiology 121(4):707–718
Liao P, Luo Q, Elsaid H, Kang W, Shapiro CM, Chung F (2013) Perioperative auto-titrated continuous positive airway pressure treatment in surgical patients with obstructive sleep apnea: a randomized controlled trial. Anesthesiology 119(4):837–847
Joshi GP, Ankichetty SP, Gan TJ, Chung F (2012) Society for Ambulatory Anesthesia consensus statement on preoperative selection of adult patients with obstructive sleep apnea scheduled for ambulatory surgery. Anesth Analg 115(5):1060–1068
Knill RL, Moote CA, Skinner MI et al (1990) Anesthesia with abdominal surgery leads to intense REM sleep during the first postoperative week. Anesthesiology 73(1):52–61
Gali B, Whalen FX, Schroeder DR et al (2009) Identification of patients at risk for postoperative respiratory complications using a preoperative obstructive sleep apnea screening tool and postanesthesia care assessment. Anesthesiology 110(4):869–877
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Corso, R.M., Cortegiani, A., Gregoretti, C. (2016). Obstructive Sleep Apnoea Syndrome: What the Anesthesiologist Should Know. In: Chiumello, D. (eds) Topical Issues in Anesthesia and Intensive Care. Springer, Cham. https://doi.org/10.1007/978-3-319-31398-6_8
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