Identification of Patients at Risk for Postoperative Respiratory Complications Using a Preoperative Obstructive Sleep Apnea Screening Tool and Postanesthesia Care Assessment

Abstract

PATIENTS with obstructive sleep apnea (OSA) are at risk for perioperative morbidity, and many patients who present for surgical procedures may have undiagnosed OSA.1–5 In 1993, approximately 4% of men and 2% of women in the age group of 30–60 yr were presumed to have OSA, and it is now known to be an independent risk factor for increased mortality.6,7 It is estimated that between 1990 and 1998, there was a 12-fold increase in the diagnosis of OSA in surgical outpatients.8 Anesthetic and analgesic agents used during the perioperative period can decrease pharyngeal tone and depress ventilatory responses to hypoxia and hypercapnia.1,9 These effects can exacerbate the underlying anatomical and physiologic abnormality associated with OSA. In one recent study, 24% of patients with OSA had significant postoperative complications, compared with 9% of patients in the control group.3 The American Academy of Sleep Medicine 2003 practice guidelines state that “there is insufficient information to develop an American Academy of Sleep Medicine standards of practice recommendation” and recommended careful attention to perioperative airway management and appropriate monitoring.10 The American Society of Anesthesiologists (ASA) addressed this issue in 2006 with practice guidelines including assessment of patients for possible OSA before surgery and careful postoperative monitoring for those suspected to be at high risk.11