Review article

Obstructive sleep apnea and anesthesia - Time to wake up !

Tatjana Šimurina orcid.org/0000-0002-2657-5537 ; General Hospital Zadar, Department of Anesthesiology, reanimation and intensive care; University of Zadar, Departmet for health study; University of Osijek
Mirela Palić ; University of Zadar, Department for health study
Boris Mraović ; Department of Anesthesiology and Perioperative Medicine, University of Missoury

Abstract

Obstructive sleep apnea (OSA) is the most common breathing sleep disorder characterized by collapse of the upper airway which is caused by reduced pharyngeal muscle tone and exaggerated negative intrathoracic pressure during respiratory effort on breathing. It is accompanied by episodes of arterial blood desaturation, hypercarbia and recurrent awakenings from sleep and loud snoring. Clinical signs and anatomical characteristics that indicate OSA are loud snoring, witnessed abnormal cessation of breathing during sleep, abdominal type of obesity, thickened neck and abnormal anatomy of the pharynx. Clinical symptoms of the obstructive sleep apnea is most commonly manifested as unexplained excessive daytime sleepiness, cardiopulmonary disorders and cortical dysfunction. The majority of patients with obstructive sleep apnea are not diagnosed before preoperative visit with potentially serious or even fatal perioperative complications. Complications are usually due to unanticipated difficult airway, aspiration, increased sensitivity to anesthetics, and complications due to multiple concomitant cardiovascular and cerebrovascular diseases, and postoperative delirium. Recognizing the symptoms of obstructive sleep apnea prior to surgery allows timely anesthesia planning, choice of appropriate anesthesia technique and perioperative monitoring, which is particularly important in daily surgery patients. Assessment of the quality of sleep, risk factors for disorders of breathing during sleep and excessive daytime sleepiness and the use of questionnaires allows easy, cheap, and reliable early detection of OSA in surgical patients. Perioperative complications can be reduced by the implementation of anesthetic protocols and strategies for reducing risks in patients with OSA. Further improvements of protocols should be evidence based.

Keywords

obstructive sleep apnea; screening tests; questionnares; diagnosis; comorbidity; perioperative complications; anesthesia

Hrčak ID:

187095

URI

https://hrcak.srce.hr/187095

Publication date:

3.10.2017.

Article data in other languages: croatian

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