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Obstructive Sleep Apnea (OSA) 

 

 

Considerations 

 

  • Potentially difficult BMV & intubation

  • ↑ sensitivity to sedatives/hypnotics

  • Potential for cardiorespiratory changes:

    • Hypoxia, hypercarbia (chronic)

    • Obesity hypoventilation syndrome

    • Polycythemia

    • Pulmonary hypertension, RV hypertrophy, RV dysfunction

  • Comorbid disease:

    • Obesity, diabetes, coronary artery disease, congenital syndromes affecting the airway

  • ↑ risk of perioperative complications → require intensified monitoring:

    • Obstruction with induction

    • Apnea & desaturation in PACU

 

 

Goals 

 

  • Safe establishment of airway

  • Minimize risk of postoperative respiratory depression:

    • Minimize long acting narcotics (systemic & neuraxial) due to patient sensitivity & risk of opioid-induced upper airway obstruction

  • Provide monitoring adequate to decrease morbidity from postoperative apnea

 

 

Conflicts 

 

  • Aspiration risk (RSI) vs. OSA (difficult airway)

  • Desire to minimize narcotic use vs. contraindication/inability for regional

 

 

STOP-BANG Questionnaire: ≥3 features indicates high risk of OSA

 

  • S noring

  • T ired excessively

  • O bserved apneas

  • P ressure (hypertension)

  • B MI > 35

  • A ge > 50

  • N eck circumference > 40 cm

  • G ender = male

 

 

Apnea Hypopnea Index & Severity of OSA

 

  • Mild = 5-15

  • Moderate = 15-30

  • Severe = >30

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