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Sleep Disordered Breathing and Anesthesia: Definitions

Sleep disordered breathing and anesthesia can present risks that require screening and management. Obstructive sleep apnea (OSA) involves pauses in breathing or reduced air flow during sleep and is common, with over 80% of cases undiagnosed. Perioperative care of patients with OSA requires screening tools like STOP-BANG to assess risk, use of regional anesthesia when possible, minimizing opioids and early mobilization to reduce risk, and reinstitution of CPAP postoperatively. Untreated OSA can progress and lead to serious health issues, so identifying and managing these patients is important for safe anesthesia and recovery.

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Muhammad Syamm
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63 views1 page

Sleep Disordered Breathing and Anesthesia: Definitions

Sleep disordered breathing and anesthesia can present risks that require screening and management. Obstructive sleep apnea (OSA) involves pauses in breathing or reduced air flow during sleep and is common, with over 80% of cases undiagnosed. Perioperative care of patients with OSA requires screening tools like STOP-BANG to assess risk, use of regional anesthesia when possible, minimizing opioids and early mobilization to reduce risk, and reinstitution of CPAP postoperatively. Untreated OSA can progress and lead to serious health issues, so identifying and managing these patients is important for safe anesthesia and recovery.

Uploaded by

Muhammad Syamm
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Sleep Disordered Breathing and Anesthesia

Signs and
1 - Understand it Symptoms
May be subtle!
Definitions Actively seek OSA in EVERY
Apnea: a cessation of air flow >10
patient
seconds
Hypopnea: - a 30-50% reduction of air
flow > 10 seconds associated with a fall in Spectrum of Disease
SpO2 •  Mild OSA is common (15% of
Apnea / Hypopnea Index: (AHI) # of adult males).
events per hour •  The undiagnosed moderate to
Respiratory Effort-Related Arousal: severe OSA patients are at
(RERA) - 10 second episode of reduced greatest risk in the peri-operative
airflow leading to arousal, but not quite a period.
Hypopnea
Classification: Progression of Disease
Mild = AHI 5-15 •  Moderate to severe OSA leads to
Moderate = AHI 15-30 hypertension, heart failure, and
Severe = AHI > 30 multiple other health problems.
>80% of patients with •  Some patients develop
Pre-disposing Factors Sleep Apnea  hypoventilation with CO2
Small Mouth - Receding Jaw - Large are undiagnosed! retention over time
Tonsils - Nasal Obstruction

2 - Seek it 3 - Manage it
Screening Tools
OSA Safe Anesthesia Principles
S
Snoring: Do you snore loudly (loud enough
Yes No •  Expect a difficult airway
to be heard through closed doors)? •  Regional if possible (caution with intrathecal opioids)
Tired: Do you often feel tired, fatigued or
•  If general anesthesia, use short acting agents
T Yes No •  Minimize opioids - use enhanced recovery principles.
sleepy during the daytime? •  Short acting
Observed: Has anyone observed you stop •  Avoid basal rates on PCA pumps
O Yes No •  Consider Multimodal analgesia
breathing during your sleep?
•  Ensure full reversal of NMB agents
Blood pressure: Do you have or are you •  Sit up for extubation
P Yes No •  Mobilize early
being treated for high blood pressure?

B BMI: BMI more than 35 kg/m2 Yes No


Post-op Care
A Age: Age over 50 years Yes No •  Sit up in bed and position laterally if able.
Neck circumference: Neck circumference •  Very cautious with opioids
N Yes No •  If high risk then monitor with oximetry
> 40 cm

G Gender: Male Yes No Post-op CPAP


•  Re-institute CPAP masks ASAP on day of surgery for
Total Score those on home PAP therapy
•  Check ABG if somnolent:
STOP-BANG Score of 3-4 at risk. Score 5-8 high risk - if PaCO2 >10mmHg above norm
With permission: Toronto Western Hospital, UHN,University of Toronto  then consider bilevel pressure support

Long term
Discuss long-term health risks
Follow-up sleep evaluation

Further resources
www.SASMHQ.org

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