Indian Journal of Sleep Medicine

Register      Login

VOLUME 6 , ISSUE 2 ( April-June, 2011 ) > List of Articles

REVIEW ARTICLE

Perioperative management of adult and pediatric sleep apnoea

Dipti Gothi

Keywords : Excessive daytime sleepiness (EDS), obstructive sleep apnea (OSA), continuous positive airway pressure (CPAP), apnea hypopnea index (AHI)

Citation Information : Gothi D. Perioperative management of adult and pediatric sleep apnoea. Indian Sleep Med 2011; 6 (2):35-43.

DOI: 10.5005/ijsm-6-2-35

License: NA

Published Online: 01-08-2018

Copyright Statement:  NA


Abstract

Amongst the various diseases required to be screened preoperatively obstructive sleep apnoea (OSA) is one of the most underdiagnosed conditions. The various screening tools devised to prevent OSA related postoperative complications are: Berlin questionnaire, STOP-BANG questionnaire, American Society of Anesthesiologist checklist and Perioperative Sleep Apnea Prediction Score. Among these, the STOP –BANG questionnaire is validated, sensitive, specific and viable and can even be self administered. Portable sleep study is the most practicable approach to confirm the diagnosis preoperatively in suspected cases. Continuous positive airway pressure (CPAP) administration is recommended for reducing the risk of complications related to OSA during post and or pre operative period although; the data describing the impact of CPAP therapy on adverse outcomes are limited. Also, close monitoring of patients postoperatively; avoiding use of sedatives and awake extubation are important components of postoperative care. Using CPAP in pre and or postoperative period can not only reduce the postoperative complication but also diagnose and sensitize the patients towards the long term management of OSA. The perioperative management of pediatric OSA is also similar to adult OSA, though clinically both are different.


PDF Share
  1. Ogden C, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA 2006; 295:1549-55.
  2. Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK. Interactions between obesity and obstructive sleep apnea:implications for treatment. Chest 2010;137:711-9.
  3. Adesanya AO, Lee W, Greilich NB and Joshi GP. Perioperative Management of Obstructive Sleep Apnoea. Chest 2010;138;1489-98.
  4. Gross JB, Bachenberg KL, Benumof JL, et al. Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea: Report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Obstructive Sleep Apnea. Anesthesiology 2006;104:1081–93.
  5. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002;165:1217–39.
  6. Ancoli-Israel S, Kripke DF, Klauber MR, Mason WJ, Fell R, Kaplan O. Sleep-disordered breathing in communitydwelling elderly. Sleep 1991;14:486-95.
  7. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230-1235.
  8. Kapur V, Strohl KP, Redline S, Iber C, O'Connor G, Nieto J. Underdiagnosis of sleep apnea syndrome in U.S. communities. Sleep Breath 2002;6:49-54.
  9. Saxena S, Gothi D, Joshi JM. Prevalence of symptoms and risk of sleep disordered breathing in Mumbai (India). Indian J Sleep Med 2006;1.1:27-31.
  10. Finkel KJ, Searleman AC, Tymkew H, et al. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med 2009;10:753-58.
  11. Fidan H, Fatma F, Mehmet U, Yuksel E, Arif I, Levent T. Prevalence of sleep apnoea in patients undergoing operation. Sleep Breath 2006;10:161–5
  12. Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg 2003;13:676-83.
  13. Lopez PP, Stefan B, Schulman CI, et al. Prevalence of sleep apnea in morbidly obese patients who presented for weight loss surgery evaluation: more evidence for routine screening for obstructive sleep apnea before weight loss surgery Am Surg 2008;74: 834 -838.
  14. Shafazand S. Perioperative management of obstructive sleep apnea: Ready for prime time? Cleveland Clinic Journal Of Medicine 2009;76:S98- S103.
  15. Gupta RM, Parvizi J, Hanssen AD, Gay P C. Postoperative Complications in Patients With Obstructive Sleep Apnea Syndrome Undergoing Hip or Knee Replacement: A Case- Control study. Mayo Clin Proc 2001;76:897-905.
  16. Jain SS, Dhand R. Perioperative treatment of patients with obstructive sleep apnoea. Curr Opin Pulm Med. 2004;10:482-8.
  17. Meoli AL, Rosen CL, Kristo D, et al. Clinical Practice review committee; American Academy of Sleep Medicine. Upper airway management of the adult patient with obstructive sleep apnoea in perioperative period – avoiding complications. Sleep 2003;26:1060-5.
  18. Kaw R, Michota F, Jaffer A, et al. Unrecognized sleep apnea in the surgical patient: implications for the perioperative setting. Chest 2006;129:198-205.
  19. Hwang D, Shakir N, Limann B, et al. Association of sleepdisordered breathing with postoperative complications. Chest 2008;133:1128-34.
  20. Ostermeier AM, Raizen MF, Hautkappe M, Klock PA, Klafta JM. Three sudden postoperative respiratory arrest associated with epidural opioids in patients with sleep apnoea. Anesth Analg 1997;85:452-60.
  21. Parikh SN, Stuchin SA, Maca C, Fallar E, Steiger D. Sleep apnea syndrome in patients undergoing total joint arthroplasty. J Arthroplasty 2002;17:635-42.
  22. Reeder MK, Goldman MD, Loh L, et al. Postoperative obstructive sleep apneua. Haemodynamic effects of treatment with nasal CPAP. Anaesthesia 1991;46:849-53.
  23. Reeder MK, Muir AD, Foex P, Goldman MD, Loh L, Smart D. postoperative myocardial ischemia temporal association with nocturnal hypoxaemia. Br J Anaesth 1991;67:626-31.
  24. Marcus CL. Pathophysiology of childhood obstructive sleep apnea: current concepts. Respir Physiol 2000;119:143–54
  25. Patil SP, Schneider H, Schwartz AR, Smith PL. Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest 2007;132:325-37.
  26. Isono S, Remmers JE, Tanaka A, Sho Y, Sato J, Nishino T. Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects. J Appl Physiol 1997;82:1319-26.
  27. Sforza E, Petiau C, Weiss T, Thibault A, Krieger J. Pharyngeal critical pressure in patients with obstructive sleep apnea syndrome. Clinical implications. Am J Respir Crit Care Med.1999;159:149-57.
  28. Younes M. Contributions of upper airway mechanics and control mechanisms to severity of obstructive apnea. Am J Respir Crit Care Med 2003;168: 645-58.
  29. Bachar G, Feinmesser R, Shpitzer T, Yaniv E, Nageris B, Eidelman L. Laryngeal and hypopharyngeal obstruction in sleep disordered breathing patients, evaluated by sleep endoscopy. Eur Arch Otorhinolaryngol 2008;265:1397–1402.
  30. Waters KA, McBrien F, Stewart P, Hinder M, Wharton S. Effects of OSA, inhalational anesthesia, and fentanyl on the airway and ventilation of children. J Appl Physiol 2002;92:1987-94.
  31. Strauss SG, Lynn AM, Bratton SL, Nespeca MK. Ventilatory response to CO2 in children with obstructive sleep apnea from adenotonsillar hypertrophy. Anesth Analg 1999;89:328-32.
  32. Rosenberg J, Wildschiødtz G, Pedersen MH, von Jessen F, Kehlet H. Late postoperative nocturnal episodic hypoxaemia and associated sleep pattern. Br J Anaesth 1994 ;72:145 -50.
  33. Chung F, Ward B, Ho J, Yuan H, Kayumov, Shapiro C. Preoperative identification of sleep apnea risk in elective surgical patients, using the Berlin questionnaire. J Clin Anesth 2007;19:130-4.
  34. Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 2008;108:812-21.
  35. Vasu TS, Doghramji K, Cavallazzi R, et al. Obstructive Sleep Apnea Syndrome and Postoperative Complications Clinical Use of the STOP-BANG Questionnaire. Arch Otolaryngol Head Neck Surg. 2010;136(10):1020-1024.
  36. Ramachandran SK, Kheterpal S, Consens F, et al. Derivation and Validation of a Simple Perioperative Sleep Apnea Prediction Score Anesth Analg 2010;110:1007–15.
  37. Chesson A, Ferber R, Fry J, et al. Practice parameters for the indications for polysomnography and related procedures. Polysomnography Task Force, American Sleep Disorders Association Standards of Practice Committee. Sleep. 1997;20:406-22.
  38. Kushida CA, Littner MR, Morgenthaler T, et al. Practice Parameters for the Indications for Polysomnography and Related Procedures: An Update for 2005. Sleep 2005;28:499-520.
  39. Collop NA, Anderson WM, Boehlecke B, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2007;15:737-47.
  40. Drummond F, Doelken P, Ahmed QA, et al. Empiric autotitrating CPAP in people with suspected obstructive sleep apnea. J Clin Sleep Med. 2010;6:140-5.
  41. Giles TL, Lasserson TJ, Smith BH, White J, Wright J, Cates CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev 2006;3:CD001106 [Review].
  42. Hillman DR, Loadsman JA, Platt PR, Eastwood PR. Obstructive sleep apnoea and anaesthesia. Sleep Med Rev 2004;8:459-64.
  43. Boushra NN. Anaesthetic management of patients with sleep apnoea syndrome. Can J Anaesth 1996; 43:599-616.
  44. Chung SA, Yuan H, Chung F. A systemic review of obstructive sleep apnea and its implications for anesthesiologists. Anesth Analg 2008;107:1543-63.
  45. Delay JM, Sebbane M, Jung B, et al. The effectiveness of noninvasive positive pressure ventilation to enhance preoxygenation in morbidly obese patients: a randomized controlled study. Anesth Analg 2008;107:1707–13
  46. Dixon BJ, Dixon JB, Carden JR, et al. Preoxygenation is more effective in the 25 degrees head-up position than in the supine position in severely obese patients: a randomized controlled study. Anesthesiology 2005;102:1110-5.
  47. Hiremath AS, Hillman DR, James AL, et al. Relationship between difficult tracheal intubation and obstructive sleep apnoea. Br J Anaesth 1998;80:606-11.
  48. Benumof JL. Obstructive sleep apnea in the adult obese patient: implications for airway management. Anesthesiol Clin North America 2002;20:789-811.
  49. Meoli AL, Rosen CL, Kristo D, et al. Upper airway management of the adult patient with obstructive sleep apnea in the perioperative period—avoiding complications. Sleep 2003;26:1060-5.
  50. Stierer TL, Wright C, George A, et al. Risk assessment of obstructive sleep apnea in a population of patients undergoing ambulatory surgery. J Clin Sleep Med 2010;6:467-72.
  51. Deegan PC, Mulloy E, McNicholas WT. Topical oropharyngeal anesthesia in patients with obstructive sleep apnea. Am J Respir Crit Care Med 1995;151:1108-1112.
  52. Berry RB, Kouchi KG, Bower JL, Light RW. Effect of upper airway anesthesia on obstructive sleep apnea. Am J Respir Crit Care Med 1995;151:1857-1861.
  53. Caplan RA, Benumof JL, Blitt CD, et al. American Society of Anesthesiologists Task Force on Difficult Airway Management: Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2003;98:1269–77.
  54. Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981;1:862-865.
  55. Rennotte MT, 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;107:367-74.
  56. West SD, Jones DR, Stradling JR. Comparison of 3 ways to determine and deliver pressure during nasal CPAP therapy for OSA. Thorax 2006;61:226–31.
  57. Hukins CA. Arbitrary-pressure continuous positive airway pressure for OSAS. American Respiratory Journal of Critical Care Medicine 2005;171:500-5.
  58. Hwang D, Shakir N, Limann B, et al. Association of sleep disordered breathing with postoperative complications. Chest 2008;133:1128-1134.
  59. Lee CH, Shin HW, Han DH. The implication of sleep position in the evaluation of surgical outcomes in obstructive sleep apnea. Otolaryngol Head Neck Surg 2009;140:531-5.
  60. Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: a review of clinical applications. Curr Opin Anaesthesiol 2008;21:457-61.
  61. Schechter MS. Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. Technical report: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002;109:e69.
  62. Rosen GM, Muckle RP, Mahowald MW, Goding GS, Ullevig C. Postoperative respiratory compromise in children with obstructive sleep apnea syndrome: can it be anticipated? Pediatrics 1994;93:784–8.
  63. Brown KA, Laferriere A, Moss IR. Recurrent hypoxemia in young children with obstructive sleep apnea is associated with reduced opioid requirement for analgesia. Anesthesiology 2004;100:806–10.
  64. Sanders JC, King MA, Mitchell RB, Kelly JP. Perioperative complications of adenotonsillectomy in children with obstructive sleep apnea syndrome. Anesth Analg 2006;103:1115–21.
  65. Statham MM, Elluru RG, Buncher R, Kalra M. Adenotonsillectomy for obstructive sleep apnea syndrome in young children: prevalence of pulmonary complications. Arch Otolaryngol Head Neck Surg 2006;132:476–80.
  66. Nixon GM, Kermack AS, McGregor CD, et al. Sleep and breathing on the first night after adenotonsillectomy for obstructive sleep apnea. Pediatr Pulmonol2005;39:332–8.
  67. Brown KA, Morin I, Hickey C, Manoukian JJ, Nixon GM, Brouillette RT. Urgent adenotonsillectomy: an analysis of risk factors associated with postoperative respiratory morbidity. Anesthesiology 2003;99:586–95.
  68. Wilson K, Lakheeram I, Morielli A, Brouillette R, Brown K. Can assessment for obstructive sleep apnea help predict postadenotonsillectomy respiratory complications? Anesthesiology 2002;96:313–22.
  69. Chau KW, Ng DK, Kwok CK, Chow PY, Ho JC. Clinical risk factors for obstructive sleep apnoea in children. Singapore Med J 2003;44:570–3.
  70. Rosen CL. Obstructive sleep apnea syndrome in children: diagnostic challenges. Sleep 1996;19(suppl 10):S274–S7.
  71. Marcus CL. Clinical and pathophysiological aspects of obstructive sleep apnea in children. Pediatr Pulmonol Suppl 1997;16:123–4.
  72. Guilleminault C Lee JH, Chan A. Pediatric Obstructive Sleep Apnea Syndrome Arch Pediatr Adolesc Med. 2005;159:775-85.
  73. Rennotte MT, Baele P, Aubert G, Rodenstein DO. Nasal continuous positive airway pressure in the perioperative management of patients with obstructive sleep apnea submitted to surgery. Chest1995;107:367–74.
  74. Ryan CF, Lowe AA, Li D, Fleetham JA. Magnetic resonance imaging of the upper airway in obstructive sleep apnea before and after chronic nasal continuous positive airway pressure therapy. Am Rev Respir Dis 199;144:939–44.
  75. Marcus CL, Ward SL, Mallory GB, et al. Use of nasal continuous positive airway pressure as treatment of childhood obstructive sleep apnea. J Pediatr1995;127:88–94.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.