Abstract
Background
Patients with sleep-disordered breathing often show upper airway narrowing due to anatomical factors, which can be treated surgically. The paraoperative risk for sleep apnea patients is discussed from different points of view. We studied the effects of general anesthesia which is mainly used for surgery on the degree of disordered breathing.
Methods
After two nights of polysomnographie 20 healthy subjects with snoring, light or severe sleep apnea were scheduled for surgery of the nose, the paranasal sinuses, the tonsils and/or the soft palate. A common screening device for disordered breathing was installed preoperatively. The raw data for snoring, oxygen saturation, heart rate and body position were edited visually in order to match them with polysomnography. Preoperative results were compared to the four hours following extubation and the first postoperative night.
Results
Neither the respiratory disturbance indexes (RDI) nor the oxygen saturations nor the times of snoring differed significantly during the three examinations. Worsening was only found in the subgroup with predominantly mixed apnea. There was only one patient with a modified uvulo-palato-pharyngoplasty(UPPP) who had to be reintubated twelve hours after surgery due to massive oropharyngeal swelling. Patients without palatal surgery did not show any complications.
Conclusion
According to our experience surgically treated sleep apnea patients without any other cardiopulmonary disease may be kept in the general ENT ward. After oropharyngeal surgery intensive wound controls are required.
Similar content being viewed by others
Literatur
BachmannW. Rhinomanometrie. In: Naumann H H, Helms J, Herberhold C, Kastenbauer E (Hrsg). Oto-Rhino-Laryngologie in Klinik und Praxis, Bd. 2. Thieme, Stuttgart New York 1992, pp 79–82
Bailey PL, Pace NL, Ashburn MA, Moll JW, East KA, Stanley TH. Frequent hypoxemia and apnea after sedation with midazolam and fentanyl. Anesthesiology 1990; 73: 826–830
Biro P, Kaplan V, Bloch KE. Anesthetic management of a patient with obstructive sleep apnea syndrome and difficult airway access. J Clin Anesth 1995;7:417–421
Conolly LA. Anesthetic management of obstructive sleep apnea patients. J Clin Anesth. 1991; 3: 461–469
Esclamado RM, Glenn MG, McCulloch TM, Cummings CW. Perioperative complications in the surgical treatment of obstructive sleep apnea syndrome. Laryngoscope 1989; 99:1125–1129
Katsantonis GP. Limitations, pitfalls and risk mangement in uvulopalatopharyngoplasty. In: Fairbanks NF, Fujita S (Hrsg) Snoring and obstructive Sleep Apnea. Raven Press, New York 1994, pp 145–162
Kearny MF, Cadieux RJ, Kofke WA, Kales A. The occurrence of obstructive sleep apnea in a recovery room patient. Anesthesiology 1987; 66: 232–234
Penzel T, Hajak G, Hoffmann RM, Podszus T, Pollmächer T et al. Empfehlungen zur Durchführung und Auswertung polygraphischer Ableitungen im diagnostischen Schlaflabor. EEG-EMG 1993;24:65–70
Podszus T. Therapie der Schlafapnoe. Pneumologie 1989; 43: 639–642
Rafferty TD, Ruskis AS, Sasaki C, Gee JB. Perioperative considerations in the managemnt for the obstructive sleep apnoea patient. J Anaesth 1980; 52: 619–622
Renotte M-T, Baele P, Aubert G, Rodenstein DO. Nasal continuous positive airway pressure in the perioperative management of patients with obstructive sleep apnea submitted to surgery. Chest 1995; 107: 367–374
Rosenberg J, Kehlet H. Postoperative episodic oxygen desaturation in the sleep apnea syndrome. Acta anaesthesiol Scand 1991; 35: 368–369
Sanner B, Wiemann J, Sturm A. Welche Bedeutung hat das obstruktive Schlafapnoe-syndrom postoperativ oder auf Intensivstationen? DMW 1992; 117: 1122–1123
Schramm E, Riemann D (Hrsg). Internationale Klassifikation der Schlafstörungen. Beltz, Psychologie Verlags Union, Weinheim 1995
Stoohs R, GuilleminaultC. MESAM IV: An ambulatory device for the detection of patients at risk for obstructive sleep apnea syndrome (OSAS). Chest 1992; 101: 1221–1227
Wechsler JG, Schusdziarra V, HaunerH, Gries FA. Therapie der Adipositas. Dt Ärztebl 1996; 93: A-2214–2218
Wellhöner HH. Allgemeine und systematische Pharmakologie und Toxikologie. Springer, Berlin Heidelberg New York 1988
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Maurer, J., Juncker, C., Dworschak, M. et al. Paraoperative change of sleep-disordered breathing in healthy snorers and sleep apnea patients compared to preoperative values. Sleep Breath 2, 50–55 (1997). https://doi.org/10.1007/BF03038973
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03038973