Perioperative Care of the Orthopedic Patient with Sleep-Disordered Breathing: Obstructive Sleep Apnea

  • Crispiana Cozowicz
  • Stavros G. MemtsoudisEmail author


Obstructive sleep apnea presents a well-recognized driver of perioperative complications. Considering the implications of this condition, coupled with the high prevalence particularly in orthopedic surgery, the adequate perioperative identification and management of obstructive sleep apnea is increasingly becoming a priority in clinical practice and scientific research. The current body of evidence and existent guideline recommendations for the perioperative setting emphasize the need for the implementation of perioperative risk management strategies to increase patient safety in this patient population. Obstructive sleep apnea-related complications are increasingly recognized in the legal field with prevalent litigation cases involving death and anoxic brain injury due to airway management complications and respiratory failure. Moreover, critical life-threatening OSA-related complications are often deemed as preventable with a systematic and cautious approach to perioperative care. This chapter focuses on current evidence, knowledge and clinical recommendations in respect to the perioperative care of surgical patients at risk or diagnosed with OSA.


Obstructive sleep apnea (OSA) Perioperative management OSA screening Postoperative complications Perioperative complications Airway obstruction Respiratory complications Respiratory failure Continuous positive airway pressure (CPAP) Oximetry Postoperative monitoring 



Stavros G. Memtsoudis is a director on the boards of the American Society of Regional Anaesthesia and Pain Medicine (ASRA) and the Society of Anaesthesia and Sleep Medicine (SASM). He is a one-time consultant for Sandoz Inc. and the holder US Patent Multicatheter Infusion System US-2017-0361063. He is the owner of SGM Consulting, LLC, and co-owner of FC Monmouth, LLC. None of the above relations influenced the conduct of the present study.


  1. 1.
    Horner RL, Mohiaddin RH, Lowell DG, Shea SA, Burman ED, Longmore DB, et al. Sites and sizes of fat deposits around the pharynx in obese patients with obstructive sleep apnoea and weight matched controls. Eur Respir J. 1989;2(7):613–22.PubMedGoogle Scholar
  2. 2.
    Chung SA, Yuan H, Chung F. A systemic review of obstructive sleep apnea and its implications for anesthesiologists. Anesth Analg. 2008;107(5):1543–63.CrossRefGoogle Scholar
  3. 3.
    Gammon BT, Ricker KF. An evidence-based checklist for the postoperative management of obstructive sleep apnea. J Perianesth Nurs. 2012;27(5):316–22.PubMedCrossRefGoogle Scholar
  4. 4.
    Ogan OU, Plevak DJ. Anesthetic safety always an issue with obstructive sleep apnea. J Clin Monit Comput. 1998;14(1):69–70.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Memtsoudis SG, Stundner O, Rasul R, Chiu YL, Sun X, Ramachandran SK, et al. The impact of sleep apnea on postoperative utilization of resources and adverse outcomes. Anesth Analg. 2014;118(2):407–18.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Finkel KJ, Searleman AC, Tymkew H, Tanaka CY, Saager L, Safer-Zadeh E, et al. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med. 2009;10(7):753–8.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Reed K, Pengo MF, Steier J. Screening for sleep-disordered breathing in a bariatric population. J Thorac Dis. 2016;8(2):268–75.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20(9):705–6.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Littleton SW, Mokhlesi B. The pickwickian syndrome-obesity hypoventilation syndrome. Clin Chest Med. 2009;30(3):467–78, vii–viiiPubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Resta O, Foschino-Barbaro MP, Legari G, Talamo S, Bonfitto P, Palumbo A, et al. Sleep-related breathing disorders, loud snoring and excessive daytime sleepiness in obese subjects. Int J Obes Relat Metab Disord. 2001;25(5):669–75.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Harrison MM, Childs A, Carson PE. Incidence of undiagnosed sleep apnea in patients scheduled for elective total joint arthroplasty. J Arthroplast. 2003;18(8):1044–7.CrossRefGoogle Scholar
  12. 12.
    James PT, Leach R, Kalamara E, Shayeghi M. The worldwide obesity epidemic. Obes Res. 2001;9 Suppl 4:228s–33s.Google Scholar
  13. 13.
    Mokhlesi B. Obesity hypoventilation syndrome: a state-of-the-art review. Respir Care. 2010;55(10):1347–62; discussion 63–5PubMedPubMedCentralGoogle Scholar
  14. 14.
    Balachandran JS, Masa JF, Mokhlesi B. Obesity hypoventilation syndrome epidemiology and diagnosis. Sleep Med Clin. 2014;9(3):341–7.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Mokhlesi B, Tulaimat A, Faibussowitsch I, Wang Y, Evans AT. Obesity hypoventilation syndrome: prevalence and predictors in patients with obstructive sleep apnea. Sleep Breath. 2007;11(2):117–24.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Ayas NT, Laratta CR, Coleman JM, Doufas AG, Eikermann M, Gay PC, et al. Knowledge gaps in the perioperative management of adults with obstructive sleep apnea and obesity hypoventilation syndrome. An Official American Thoracic Society workshop report. Ann Am Thorac Soc. 2018;15(2):117–26.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Manuel ARG, Hart N, Stradling JR. Is a raised bicarbonate, without hypercapnia, part of the physiologic spectrum of obesity-related hypoventilation? Chest. 2015;147(2):362–8.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Chung F, Chau E, Yang Y, Liao P, Hall R, Mokhlesi B. Serum bicarbonate level improves specificity of STOP-bang screening for obstructive sleep apnea. Chest. 2013;143(5):1284–93.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Kaw R, Bhateja P, Paz YMH, Hernandez AV, Ramaswamy A, Deshpande A, et al. Postoperative complications in patients with unrecognized obesity hypoventilation syndrome undergoing elective noncardiac surgery. Chest. 2016;149(1):84–91.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Chau EH, Lam D, Wong J, Mokhlesi B, Chung F. Obesity hypoventilation syndrome: a review of epidemiology, pathophysiology, and perioperative considerations. Anesthesiology. 2012;117(1):188–205.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Castaneda A, Jauregui-Maldonado E, Ratnani I, Varon J, Surani S. Correlation between metabolic syndrome and sleep apnea. World J Diabetes. 2018;9(4):66–71.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Kaw R, Chung F, Pasupuleti V, Mehta J, Gay PC, Hernandez AV. Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome. Br J Anaesth. 2012;109(6):897–906.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Chung F, Memtsoudis S, Krishna Ramachandran S, Nagappa M, Opperer M, Cozowicz C, et al. Society of Anesthesia and Sleep Medicine Guideline on preoperative screening and assessment of patients with obstructive sleep apnea. Anesth Analg. 2016;123(2):452–73.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Fouladpour N, Jesudoss R, Bolden N, Shaman Z, Auckley D. Perioperative complications in obstructive sleep apnea patients undergoing surgery: a review of the legal literature. Anesth Analg. 2016;122(1):145–51.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Opperer M, Cozowicz C, Bugada D, Mokhlesi B, Kaw R, Auckley D, et al. Does obstructive sleep apnea influence perioperative outcome? A qualitative systematic review for the Society of Anesthesia and Sleep Medicine Task Force on preoperative preparation of patients with sleep-disordered breathing. Anesth Analg. 2016;122(5):1321–34.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Utter GH, Cuny J, Sama P, Silver MR, Zrelak PA, Baron R, et al. Detection of postoperative respiratory failure: how predictive is the Agency for Healthcare Research and Quality’s Patient Safety Indicator? J Am Coll Surg. 2010;211(3):347–54.e1–29.CrossRefGoogle Scholar
  27. 27.
    Subramani Y, Nagappa M, Wong J, Patra J, Chung F. Death or near-death in patients with obstructive sleep apnoea: a compendium of case reports of critical complications. Br J Anaesth. 2017;119(5):885–99.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Lee LA, Caplan RA, Stephens LS, Posner KL, Terman GW, Voepel-Lewis T, et al. Postoperative opioid-induced respiratory depression: a closed claims analysis. Anesthesiology. 2015;122(3):659–65.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Ramachandran SK, Haider N, Saran KA, Mathis M, Kim J, Morris M, et al. Life-threatening critical respiratory events: a retrospective study of postoperative patients found unresponsive during analgesic therapy. J Clin Anesth. 2011;23(3):207–13.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Gross JB, Apfelbaum JL, Caplan RA, Connis RT, Cote CJ, Nickinovich DG, et al. Practice guidelines for the perioperative management of patients with obstructive sleep apnea an updated report by the American Society of Anesthesiologists Task Force on perioperative management of patients with obstructive sleep apnea. Anesthesiology. 2014;120(2):268–86.CrossRefGoogle Scholar
  31. 31.
    Chung F, Abdullah HR, Liao P. STOP-bang questionnaire: a practical approach to screen for obstructive sleep apnea. Chest. 2016;149:631–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Fernandez-Bustamante A, Bartels K, Clavijo C, Scott BK, Kacmar R, Bullard K, et al. Preoperatively screened obstructive sleep apnea is associated with worse postoperative outcomes than previously diagnosed obstructive sleep apnea. Anesth Analg. 2017;125(2):593–602.PubMedCrossRefGoogle Scholar
  33. 33.
    Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med. 2002;162(8):893–900.PubMedCrossRefGoogle Scholar
  34. 34.
    Memtsoudis SG, Cozowicz C, Nagappa M, Wong J, Joshi GP, Wong DT, et al. Society of Anesthesia and Sleep Medicine Guideline on intraoperative Management of Adult Patients with Obstructive Sleep Apnea. Anesth Analg. 2018;127(4):967–87.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Nagappa M, Wong DT, Cozowicz C, Ramachandran SK, Memtsoudis SG, Chung F. Is obstructive sleep apnea associated with difficult airway? Evidence from a systematic review and meta-analysis of prospective and retrospective cohort studies. PLoS One. 2018;13(10):e0204904.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Kim JA, Lee JJ. Preoperative predictors of difficult intubation in patients with obstructive sleep apnea syndrome. Can J Anesth. 2006;53:393–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118(2):251–70.PubMedCrossRefGoogle Scholar
  38. 38.
    McNicholas WT, Ryan S. Obstructive sleep apnoea syndrome: translating science to clinical practice. Respirology. 2006;11(2):136–44.PubMedCrossRefGoogle Scholar
  39. 39.
    Horner RL, Shea SA, McIvor J, Guz A. Pharyngeal size and shape during wakefulness and sleep in patients with obstructive sleep apnoea. Q J Med. 1989;72(268):719–35.PubMedGoogle Scholar
  40. 40.
    Schwab RJ, Gupta KB, Gefter WB, Metzger LJ, Hoffman EA, Pack AI. Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. Am J Respir Crit Care Med. 1995;152(5 Pt 1):1673–89.PubMedCrossRefGoogle Scholar
  41. 41.
    Eastwood PR, Platt PR, Shepherd K, Maddison K, Hillman DR. Collapsibility of the upper airway at different concentrations of propofol anesthesia. Anesthesiology. 2005;103(3):470–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Drummond GB. Effects of extradural sufentanil and morphine on ventilation. Br J Anaesth. 1995;74(4):492–3.PubMedCrossRefGoogle Scholar
  43. 43.
    Hudgel DW, Hendricks C. Palate and hypopharynx–sites of inspiratory narrowing of the upper airway during sleep. Am Rev Respir Dis. 1988;138(6):1542–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Shorten GD, Opie NJ, Graziotti P, Morris I, Khangure M. Assessment of upper airway anatomy in awake, sedated and anaesthetised patients using magnetic resonance imaging. Anaesth Intensive Care. 1994;22(2):165–9.PubMedCrossRefGoogle Scholar
  45. 45.
    Dhonneur G, Combes X, Leroux B, Duvaldestin P. Postoperative obstructive apnea. Anesth Analg. 1999;89(3):762–7.PubMedGoogle Scholar
  46. 46.
    Cozowicz C, Poeran J, Zubizarreta N, Liu J, Weinstein SM, Pichler L, et al. Non-opioid analgesic modes of pain management reduce complications and resource utilization in obstructive sleep apnea patients after surgery. Br J Anaesth. 2019;122(1):131–40.PubMedCrossRefGoogle Scholar
  47. 47.
    Sudre EC, de Batista PR, Castiglia YM. Longer immediate recovery time after anesthesia increases risk of respiratory complications after laparotomy for bariatric surgery: a randomized clinical trial and a cohort study. Obes Surg. 2015;25(11):2205–12.PubMedCrossRefGoogle Scholar
  48. 48.
    Ehsan Z, Mahmoud M, Shott SR, Amin RS, Ishman SL. The effects of anesthesia and opioids on the upper airway: a systematic review. Laryngoscope. 2016;126(1):270–84.PubMedCrossRefGoogle Scholar
  49. 49.
    Liu FL, Cherng YG, Chen SY, Su YH, Huang SY, Lo PH, et al. Postoperative recovery after anesthesia in morbidly obese patients: a systematic review and meta-analysis of randomized controlled trials. Can J Anaesth. 2015;62(8):907–17.PubMedCrossRefGoogle Scholar
  50. 50.
    Juvin P, Vadam C, Malek L, Dupont H, Marmuse JP, Desmonts JM. Postoperative recovery after desflurane, propofol, or isoflurane anesthesia among morbidly obese patients: a prospective, randomized study. Anesth Analg. 2000;91(3):714–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Ibraheim O, Alshaer A, Mazen K, El-Dawlaty A, Turkistani A, Alkathery K, et al. Effect of bispectral index (BIS) monitoring on postoperative recovery and sevoflurane consumption among morbidly obese patients undergoing laparoscopic gastric banding. Middle East J Anaesthesiol. 2008;19(4):819–30.PubMedGoogle Scholar
  52. 52.
    Freo U, Carron M, Innocente F, Foletto M, Nitti D, Ori C. Effects of A-line Autoregression Index (AAI) monitoring on recovery after sevoflurane anesthesia for bariatric surgery. Obes Surg. 2011;21(7):850–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Murphy GS, Brull SJ. Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Anesth Analg. 2010;111(1):120–8.PubMedCrossRefGoogle Scholar
  54. 54.
    Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg. 2008;107(1):130–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Hafeez KR, Tuteja A, Singh M, Wong DT, Nagappa M, Chung F, et al. Postoperative complications with neuromuscular blocking drugs and/or reversal agents in obstructive sleep apnea patients: a systematic review. BMC Anesthesiol. 2018;18(1):91.PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    Xara D, Mendonca J, Pereira H, Santos A, Abelha FJ. Adverse respiratory events after general anesthesia in patients at high risk of obstructive sleep apnea syndrome. Braz J Anesthesiol (Elsevier). 2015;65(5):359–66.CrossRefGoogle Scholar
  57. 57.
    Weil JV, McCullough RE, Kline JS, Sodal IE. Diminished ventilatory response to hypoxia and hypercapnia after morphine in normal man. N Engl J Med. 1975;292(21):1103–6.PubMedCrossRefGoogle Scholar
  58. 58.
    Catley DM, Thornton C, Jordan C, Lehane J, Royston D, Jones J. Pronounced, episodic oxygen desaturation in the postoperative period: its association with ventilatory pattern and analgesic regimen. Anesthesiology. 1985;63(1):20–8.PubMedCrossRefGoogle Scholar
  59. 59.
    Mezzanotte WS, Tangel DJ, White DP. Influence of sleep onset on upper-airway muscle activity in apnea patients versus normal controls. Am J Respir Crit Care Med. 1996;153(6 Pt 1):1880–7.PubMedCrossRefGoogle Scholar
  60. 60.
    Dahan A, Aarts L, Smith TW. Incidence, reversal, and prevention of opioid-induced respiratory depression. Anesthesiology. 2010;112(1):226–38.PubMedCrossRefGoogle Scholar
  61. 61.
    Wang D, Rowsell L, Wong K, Yee B, Eckert DJ, Somogyi A, et al. Identifying obstructive sleep apnea patients vulnerable to opioid-induced respiratory depression-a randomized double-blind placebo-controlled crossover trial. B99 THE BEST OF EVERYTHING: HOT TOPICS IN SLEEP: American Thoracic Society; 2016:A4321-A.Google Scholar
  62. 62.
    Wang D, Somogyi AA, Yee BJ, Wong KK, Kaur J, Wrigley PJ, et al. The effects of a single mild dose of morphine on chemoreflexes and breathing in obstructive sleep apnea. Respir Physiol Neurobiol. 2013;185(3):526–32.PubMedCrossRefGoogle Scholar
  63. 63.
    Bernards CM, Knowlton SL, Schmidt DF, DePaso WJ, Lee MK, McDonald SB, et al. Respiratory and sleep effects of remifentanil in volunteers with moderate obstructive sleep apnea. Anesthesiology. 2009;110(1):41–9.PubMedCrossRefGoogle Scholar
  64. 64.
    Lynn LA, Curry JP. Patterns of unexpected in-hospital deaths: a root cause analysis. Patient Saf Surg. 2011;5(1):3.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Doufas A. Obstructive sleep apnea, pain, and opioid analgesia in the postoperative patient. Curr Anesthesiol Rep. 2014;4(1):1–9.CrossRefGoogle Scholar
  66. 66.
    Overdyk F, Dahan A, Roozekrans M, van der Schrier R, Aarts L, Niesters M. Opioid-induced respiratory depression in the acute care setting: a compendium of case reports. Pain Manag. 2014;4(4):317–25.PubMedCrossRefGoogle Scholar
  67. 67.
    Cozowicz C, Chung F, Doufas AG, Nagappa M, Memtsoudis SG. Opioids for acute pain management in patients with obstructive sleep apnea: a systematic review. Anesth Analg. 2018 Oct;127(4):988–1001.PubMedCrossRefGoogle Scholar
  68. 68.
    Ramsay MA, Saha D, Hebeler RF. Tracheal resection in the morbidly obese patient: the role of dexmedetomidine. J Clin Anesth. 2006;18(6):452–4.PubMedCrossRefGoogle Scholar
  69. 69.
    Koo SK, Choi JW, Myung NS, Lee HJ, Kim YJ, Kim YJ. Analysis of obstruction site in obstructive sleep apnea syndrome patients by drug induced sleep endoscopy. Am J Otolaryngol. 2013;34(6):626–30.PubMedCrossRefGoogle Scholar
  70. 70.
    Ravesloot MJ, de Vries N. One hundred consecutive patients undergoing drug-induced sleep endoscopy: results and evaluation. Laryngoscope. 2011;121(12):2710–6.PubMedCrossRefPubMedCentralGoogle Scholar
  71. 71.
    Deflandre E, Kempeneers D, Degey S, Poirrier R, Legros P, Brichant JF, et al. Risk factors for nocturnal hypoxemia in severe obstructive sleep apnea patients. Minerva Anestesiol. 2017;83(5):449–56.PubMedGoogle Scholar
  72. 72.
    Guay J, Choi PT, Suresh S, Albert N, Kopp S, Pace NL. Neuraxial anesthesia for the prevention of postoperative mortality and major morbidity: an overview of cochrane systematic reviews. Anesth Analg. 2014;119(3):716–25.PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Ramachandran SK, Pandit J, Devine S, Thompson A, Shanks A. Postoperative respiratory complications in patients at risk for obstructive sleep apnea: a single-institution cohort study. Anesth Analg. 2017;125(1):272–9.PubMedCrossRefGoogle Scholar
  74. 74.
    Memtsoudis SG, Stundner O, Rasul R, Sun X, Chiu YL, Fleischut P, et al. Sleep apnea and total joint arthroplasty under various types of anesthesia: a population-based study of perioperative outcomes. Reg Anesth Pain Med. 2013;38(4):274–81.PubMedPubMedCentralCrossRefGoogle Scholar
  75. 75.
    Naqvi SY, Rabiei AH, Maltenfort MG, Restrepo C, Viscusi ER, Parvizi J, et al. Perioperative complications in patients with sleep apnea undergoing total joint arthroplasty. J Arthroplast. 2017;32(9):2680–3.CrossRefGoogle Scholar
  76. 76.
    Liu SS, Chisholm MF, Ngeow J, John RS, Shaw P, Ma Y, et al. Postoperative hypoxemia in orthopedic patients with obstructive sleep apnea. HSS J. 2011;7(1):2–8.PubMedCrossRefGoogle Scholar
  77. 77.
    Chung F, Liao P, Elsaid H, Shapiro CM, Kang W. Factors associated with postoperative exacerbation of sleep-disordered breathing. Anesthesiology. 2014;120(2):299–311.PubMedCrossRefGoogle Scholar
  78. 78.
    Lam KK, Kunder S, Wong J, Doufas AG, Chung F. Obstructive sleep apnea, pain, and opioids: is the riddle solved? Curr Opin Anaesthesiol. 2016;29(1):134–40.PubMedCrossRefGoogle Scholar
  79. 79.
    Kehlet H. The stress response to surgery: release mechanisms and the modifying effect of pain relief. Acta Chir Scand Suppl. 1989;550:22–8.PubMedGoogle Scholar
  80. 80.
    Kehlet H. Manipulation of the metabolic response in clinical practice. World J Surg. 2000;24(6):690–5.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    McEntire DM, Kirkpatrick DR, Kerfeld MJ, Hambsch ZJ, Reisbig MD, Agrawal DK, et al. Effect of sedative-hypnotics, anesthetics and analgesics on sleep architecture in obstructive sleep apnea. Expert Rev Clin Pharmacol. 2014;7(6):787–806.PubMedCrossRefPubMedCentralGoogle Scholar
  82. 82.
    Chung F, Liao P, Yegneswaran B, Shapiro CM, Kang W. Postoperative changes in sleep-disordered breathing and sleep architecture in patients with obstructive sleep apnea. Anesthesiology. 2014;120(2):287–98.PubMedCrossRefPubMedCentralGoogle Scholar
  83. 83.
    Svider PF, Pashkova AA, Folbe AJ, Eloy JD, Setzen M, Baredes S, et al. Obstructive sleep apnea strategies for minimizing liability and enhancing patient safety. Otolaryngol Head Neck Surg. 2013;149:947–53.PubMedCrossRefPubMedCentralGoogle Scholar
  84. 84.
    Hess DR. Year in review 2014: patient safety. Respir Care. 2015;60(8):1197–202.PubMedCrossRefPubMedCentralGoogle Scholar
  85. 85.
    Baluch A, Mahbubani S, Al-Fadhli F, Kaye AD, Frost EA. Anesthetic care of the patient with obstructive sleep apnea. Middle East J Anaesthesiol. 2009;20(2):143–52.PubMedPubMedCentralGoogle Scholar
  86. 86.
    Porhomayon J, El-Solh A, Chhangani S, Nader ND. The management of surgical patients with obstructive sleep apnea. Lung. 2011;189(5):359–67.PubMedCrossRefPubMedCentralGoogle Scholar
  87. 87.
    Isono S, Tanaka A, Nishino T. Lateral position decreases collapsibility of the passive pharynx in patients with obstructive sleep apnea. Anesthesiology. 2002;97(4):780–5.PubMedCrossRefPubMedCentralGoogle Scholar
  88. 88.
    Penzel T, Moller M, Becker HF, Knaack L, Peter JH. Effect of sleep position and sleep stage on the collapsibility of the upper airways in patients with sleep apnea. Sleep. 2001;24(1):90–5.PubMedCrossRefPubMedCentralGoogle Scholar
  89. 89.
    Neill AM, Angus SM, Sajkov D, McEvoy RD. Effects of sleep posture on upper airway stability in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 1997;155(1):199–204.PubMedCrossRefPubMedCentralGoogle Scholar
  90. 90.
    de Lacy J, Miller-Burnett M, Bonsell P, Stith K, Sanchez S. Implementation of an innovative postoperative monitoring approach for patients with obstructive sleep apnea. Healthc Manage Forum. 2014;27(1 Suppl):S6–16.PubMedCrossRefPubMedCentralGoogle Scholar
  91. 91.
    Lee L, Weinger MB. Anesthesia Patient Safety Foundation consensus conference report: essential monitoring strategies to detect clinically significant drug-induced respiratory depression in the postoperative period. Anesth Analg. 2012;114(4):918–9.CrossRefGoogle Scholar
  92. 92.
    Bolden N, Smith CE, Auckley D, Makarski J, Avula R. Perioperative complications during use of an obstructive sleep apnea protocol following surgery and anesthesia. Anesth Analg. 2007;105(6):1869–70.PubMedCrossRefPubMedCentralGoogle Scholar
  93. 93.
    Gali B, Whalen FX, Schroeder DR, Gay PC, Plevak DJ. Identification of patients at risk for postoperative respiratory complications using a preoperative obstructive sleep apnea screening tool and postanesthesia care assessment. Anesthesiology. 2009;110(4):869–77.PubMedCrossRefPubMedCentralGoogle Scholar
  94. 94.
    Subramani Y, Singh M, Wong J, Kushida CA, Malhotra A, Chung F. Understanding phenotypes of obstructive sleep apnea: applications in anesthesia, surgery, and perioperative medicine. Anesth Analg. 2017;124(1):179–91.PubMedPubMedCentralCrossRefGoogle Scholar
  95. 95.
    McCarter T, Shaik Z, Scarfo K, Thompson LJ. Capnography monitoring enhances safety of postoperative patient-controlled analgesia. Am Health Drug Benefits. 2008;1(5):28–35.PubMedPubMedCentralGoogle Scholar
  96. 96.
    Kasuya Y, Akca O, Sessler DI, Ozaki M, Komatsu R. Accuracy of postoperative end-tidal Pco2 measurements with mainstream and sidestream capnography in non-obese patients and in obese patients with and without obstructive sleep apnea. Anesthesiology. 2009;111(3):609–15.PubMedCrossRefPubMedCentralGoogle Scholar
  97. 97.
    Lam T, Nagappa M, Wong J, Singh M, Wong D, Chung F. Continuous pulse oximetry and capnography monitoring for postoperative respiratory depression and adverse events: a systematic review and meta-analysis. Anesth Analg. 2017;125(6):2019–29.PubMedCrossRefPubMedCentralGoogle Scholar
  98. 98.
    Schumann R, Kwater AP, Bonney I, Ladd D, Kim J, Gupta A, et al. Respiratory volume monitoring in an obese surgical population and the prediction of postoperative respiratory depression by the STOP-bang OSA risk score. J Clin Anesth. 2016;34:295–301.PubMedCrossRefPubMedCentralGoogle Scholar
  99. 99.
    Mehta V, Vasu TS, Phillips B, Chung F. Obstructive sleep apnea and oxygen therapy: a systematic review of the literature and meta-analysis. J Clin Sleep Med. 2013;9(3):271–9.PubMedPubMedCentralCrossRefGoogle Scholar
  100. 100.
    Liao P, Wong J, Singh M, Wong DT, Islam S, Andrawes M, et al. Postoperative oxygen therapy in patients with OSA: a randomized controlled trial. Chest. 2017;151(3):597–611.PubMedCrossRefPubMedCentralGoogle Scholar
  101. 101.
    Yamamoto H, Akashiba T, Kosaka N, Ito D, Horie T. Long-term effects nasal continuous positive airway pressure on daytime sleepiness, mood and traffic accidents in patients with obstructive sleep apnoea. Respir Med. 2000;94(1):87–90.PubMedCrossRefPubMedCentralGoogle Scholar
  102. 102.
    Zaremba S, Shin CH, Hutter MM, Malviya SA, Grabitz SD, MacDonald T, et al. Continuous positive airway pressure mitigates opioid-induced worsening of sleep-disordered breathing early after bariatric surgery. Anesthesiology. 2016;125(1):92–104.PubMedPubMedCentralCrossRefGoogle Scholar
  103. 103.
    Abdelsattar ZM, Hendren S, Wong SL, Campbell DA Jr, Ramachandran SK. The impact of untreated obstructive sleep apnea on cardiopulmonary complications in general and vascular surgery: a cohort study. Sleep. 2015;38(8):1205–10.PubMedPubMedCentralCrossRefGoogle Scholar
  104. 104.
    Mutter TC, Chateau D, Moffatt M, Ramsey C, Roos LL, Kryger M. A matched cohort study of postoperative outcomes in obstructive sleep apnea: could preoperative diagnosis and treatment prevent complications? Anesthesiology. 2014;121(4):707–18.PubMedCrossRefPubMedCentralGoogle Scholar
  105. 105.
    Nagappa M, Mokhlesi B, Wong J, Wong DT, Kaw R, Chung F. The effects of continuous positive airway pressure on postoperative outcomes in obstructive sleep apnea patients undergoing surgery: a systematic review and meta-analysis. Anesth Analg. 2015;120(5):1013–23.PubMedCrossRefPubMedCentralGoogle Scholar
  106. 106.
    Ballard RD. Management of patients with obstructive sleep apnea. J Fam Pract. 2008;57(8 Suppl):S24–30.PubMedPubMedCentralGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Anesthesiology, Critical Care and Pain ManagementHospital for Special Surgery-Weill Cornell MedicineNew YorkUSA

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