Perioperative management of patients with obstructive sleep apnea

Obstructive sleep apnea (OSA) is very common in patients who undergo orthopedic, general and cardiac surgery. Emerging evidence suggests that patients with known or suspected OSA are at increased risk for perioperative respiratory, cardiac and cerebral complications. The magnitude of the risk is linked to the severity of OSA and aggravating diseases (e.g. pulmonary disease and obesity) as well as to comorbidities that can be aggravated by OSA (e.g. coronary artery disease). This review discusses strategies for perioperative management, covering preoperative screening for and treatment of OSA, risk evaluation, modified premedication and anesthesia as well as postoperative monitoring of OSA patients. Management of ambulatory and in-patient surgery varies. Existing protocols of perioperative management of OSA patients are helpful and merit further systematic scientific validation. © 2014 Springer-Verlag.