Obstructive sleep apnea - NYSORA

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Obstructive sleep apnea

Learning objectives

  • Manage a patient with obstructive sleep apnea (OSA) in the perioperative period

Definition and mechanisms

  • Obstructive sleep apnea (OSA) is a disorder in which a person frequently stops breathing during their sleep due to obstruction of the upper airway
  • This obstruction is caused by an inadequate motor tone of the tongue and/or airway dilator muscles and is exaggerated by excessive adipose tissue
  • OSA accompanied by excessive daytime sleepiness is termed OSA syndrome (OSAS)

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  • OSA affects 5-10% of the general population but is twice as prevalent in the population undergoing surgery

Predisposing factors

  • Obesity
  • Age 40-70
  • Male gender
  • Alcohol abuse
  • Smoking
  • Pregnancy
  • Low physical activity
  • Unemployment
  • Neck circumference > 40 cm
  • Tonsillar and adenoidal hypertrophy
  • Craniofacial abnormalities (e.g., Pierre Robin, Down’s syndrome)
  • Neuromuscular disease

Medical consequences

OSA is associated with


  • Increased risk of cerebrovascular accidents with poorer outcomes
  • Psychosocial problems
  • Decreased cognitive function 
  • Depression


  • Impaired glucose tolerance 
  • Dyslipidemia
  • Increased adrenocorticotropic hormone and cortisol concentrations
  • Testicular and ovarian dysfunction



  • Weight loss is the preferred treatment for obese patients with OSA
  • Continuous positive airway pressure (CPAP) therapy may reduce the risk of cardiac and cerebrovascular events, this effect is most pronounced in non-obese patients
  • Surgical uvulo-palato-pharyngoplasty and various supportive airway devices promoting mandibular advancement can be offered to selected patients but have lower efficacy than weight loss and CPAP

Anesthesiologic implications

  • Assess the patient preoperatively for conditions associated with OSA
  • Continue CPAP treatment during hospital admission and in the recovery room
  • Avoid the administration of sedative medication unless the patient is properly monitored 
  • OSA is associated with difficult intubation so plan accordingly
  • Use locoregional techniques where possible

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Suggested reading

  • Martinez G, Faber P. Obstructive sleep apnoea. Continuing Education in Anaesthesia Critical Care & Pain. 2011;11(1):5-8. 

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