Practical Screening of Suspected Osa Patients in the Preoperative Clinic

©International Anesthesia Research Society. Unauthorized Use Prohibited. INTRODUCTION Upper airway patency is essential for normal respiratory function. The maintenance of a patent airway is dependent primarily on the pharyngeal structures. In some individuals, there is a loss of this airway patency from collapse of pharyngeal soft tissue, and interruption of airflow occurs during sleep. Obstructive sleep apnea (OSA) is caused by repetitive partial or complete obstruction of the upper airway, characterised by episodes of breathing cessation during sleep, which lasts 10 or more seconds. From the anesthesiologists’ standpoint, OSA patients pose significant problems in the perioperative period – ranging from difficult airways, sensitivity to anesthetic agents, and postoperative adverse events. OSA has been associated with an increase in postoperative complications,1-3 and is an independent risk factor for increased morbidity and mortality.4,5 A recent retrospective matched cohort study in elective surgical patients with OSA showed that OSA patients had an increased incidence of postoperative oxygen desaturation with a hazard ratio of 2.2 In addition, there is a growing body of literature showing that OSA patients undergoing upper airway surgery,6,7 joint replacement surgery,8 and cardiac surgery9 have an increased risk of postoperative complications. Optimal patient care begins with a tailored preoperative assessment, to facilitate patient risk stratification and optimization, followed by formulation of an individualized perioperative management plan.