OBSTRUCTIVE SLEEP APNEA HYPOPNEA SYNDROME (OSAHS) IS A PREVALENT CONDITION THAT IS THOUGHT TO RESULT FROM DECREASED UPPER AIRWAY PATENCY IN SLEEP COMPARED TO WAKEFULNESS. In obstructive sleep-disor-

OBSTRUCTIVE SLEEP APNEA HYPOPNEA SYNDROME (OSAHS) IS A PREVALENT CONDITION THAT IS THOUGHT TO RESULT FROM DECREASED UPPER AIRWAY PATENCY IN SLEEP COMPARED TO WAKEFULNESS. In obstructive sleep-disordered breathing, the airway completely (apnea) or partially (hypopnea) occludes despite continued respiratory effort. Arousals from sleep temporarily restore upper airway patency, only to be followed by a repetitive cycle of airway collapse and arousal. This phenomenon produces sleep fragmentation and can lead to significant nocturnal hypoxemia. Young and colleagues reported that the estimated prevalence of sleepdisordered breathing, defined as an apnea-hypopnea index of five obstructed events per hour of sleep or higher, was 9% for women and 24% for men between the ages of 30 and 60.1 OSAHS may produce significant complications including an increased risk of hypertension,2 cardiac arrhythmias,3 myocardial infarction,4 and stroke.5,6 Apart from the risks of OSAHS itself, patients with disordered breathing during sleep may also be at risk of complications related to anesthesia and postoperative analgesia. Most published reports and reviews focus on patients undergoing surgical treatments specifically intended to treat OSAHS; much less is known about the perioperative management of OSAHS patients related to non-upper airway surgery.7,8,9,10,11,12,13,14 The risks associated with OSAHS may be due to the sleep-disordered breathing and associated pathophysiologic processes, or to difficult airway control (e.g., related to obesity or abnormal anatomy), associated comorbidity (e.g. hypoventilation, cardiovascular vulnerability, etc.) or other causes. Several recent reviews note that the role of OSAHS as a risk factor for anesthetic morbidity and mortality is considerable but not well defined.15,16,17,18 Furthermore, no consensus exists regarding optimal perioperative management of patients with OSAHS. Sometimes the anesthesia care provider’s first introduction to a patient occurs immediately prior to surgery. Without the availability of a quick screening test or a reliable clinical profile assessment, practitioners need to consider both the risk factors for and the perioperative management of potential sleep-disordered breathing in each patient. Unfortunately clinical presentation alone may be a poor predictor of the presence of OSAHS.19 The goals of this review are to synthesize available data that may help to identify patients at risk for OSAHS and to suggest anesthetic techniques and perioperative management that may minimize complications.