Sleep Apnea, Obstructive

Incidence in USA is 3–15% of the whole population (increased fourfold in last 15 y, presumably due to increase in obesity).

M:F ratio: 2.5:1.

Race with highest prevalence: Unknown.

Increased risk of pulm Htn, RV failure, and systemic Htn.

Some pts may be polycythemic and have an increased risk of CVA.

Complications associated with obesity and craniofacial and upper airway soft tissue abnormality.

Increased risk in supine position of sudden arrest postop.

Airway obstruction with sedating drugs; need for awake, sitting intubation without sedation if obstruction occurs when supine.

Increased sensitivity to sedating drugs.

Difficult airway management; mask ventilation and intubation.

Aspiration risk in the morbidly obese.

Postop airway obstruction or resp depression.

Nasal obstruction from NG tubes (e.g., may lead to resp compromise).

Have pt bring CPAP or other apparatus with them to hospital and to OR/PACU.

Apnea refers to cessation of airflow at the mouth for >10 sec.

Sleep apnea refers to repetitive episodes of upper airway occlusion during sleep, often with O ₂ sat to 85% and nearly always associated with loud snoring. Episodes of apnea often terminate with a snort or gasp.

Upper airway obstruction from relaxation of muscles of oropharynx.

Frequent periods of apnea lead to hypoxia and hypercarbia, which could lead to cor pulmonale.

Polycythemia may result from chronic hypoxia.

Nocturnal cardiac arrhythmias are common.

Monitor depth and quality of sleep along with cardiopulmonary variables in those with severe symptoms.

Another name is Pickwickian syndrome, associated with morbid obesity (see also Morbid Obesity).

Cessation of airflow due to complete obstruction of upper airway.

Narrowing due to enlarged tonsils, adenoids, uvula, low soft palate, or craniofacial abn superimposed on coexistent abn of upper airway muscle tone and/or neurologic control.

Obesity exacerbates upper airway obstruction.

Structural abnormality such as tonsillar hypertrophy, enlarged tongue, and micrognathia may contribute to airway obstruction.