Anesthetic Care of the Patient with Obstructive Sleep Apnea

REVIEW ARTICLES

ANESTHETIC CARE OF THE PATIENT WITH OBSTRUCTIVE SLEEP APNEA
AMIR BALUCH*, SUNIL MAHBUBANI**, FAHAD AL-FADHLI***, ALAN KAYE**** AND ELIZABETH A.M. FROST*****
Introduction
Obstructive sleep apnea (OSA) is an insidious, progressive disease1 that is significantly under diagnosed in the general population. It carries increased risk of difficult intubation preoperatively2 and increased risk of postoperative respiratory depression and airway collapse leading to hypoxia and possibly asphyxia3. In light of the estimated prevalence of symptomatic OSA in 5%4 of the general populace, and the fact that 80% of these patients remain undiagnosed5, it is crucial for anesthesia personnel to screen every patient undergoing anesthesia for this disorder quickly and effectively, and likewise, to have a strategy for perioperative care.

Definitions
Several commonly used terms include: 1. Obstructive Apnea: an absence of airflow during sleep for greater than 10 seconds6,7. 2. Obstructive Hypopnea: The latest manual of the American Academy of Sleep Medicine (AASM) provides two definitions of hypopnea. The recommended definition is a drop in desaturation. 3. Obstructive Sleep Apnea: recurrent apneic and/or hypopneic episodes despite continuing 6,7 . 4. Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS): symptomatic OSA. The main symptom is daytime sleepiness, but symptoms can manifest as choking or gasping during sleep, recurrent awakening during sleep, unrefreshing sleep, and impaired concentration6,7. 5. Apnea-Hypopnea Index (AHI): a tool used to diagnose and measure the severity of OSA by measuring apneic-hypopneic events per hour during sleep. An AHI greater than 5 but less than 15 is the criteria for mild OSA. Moderate OSA is defined by an AHI greater than 15 but less than 30, and severe OSA is an AHI greater than 306. Respiratory Disturbance Index (RDI) is the same measurement as AHI8.
* MD, Anesthesia Resident, Jackson Memorial Hospital/University of Miami,

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