Obstructive Sleep Apnea and Post-Operative Complications: Single Center Data, Review of Literature and Guidelines for Practicing Internists and Surgeons


Obstructive sleep apnea has been linked to higher rates of post-operative complications in some studies. We examined the prevalence of obstructive sleep apnea and its impact on post-operative complications in 125 patients (21 prospective, 104 retrospective) undergoing various elective outpatient surgeries at our institution. Ten percent of these patients had OSA, and half of them were on continuous positive airway pressure therapy (CPAP). Patients who were on CPAP as outpatients received CPAP post-operatively as well. No patients died, and the prevalence of post-operative complications was low. There was no difference in complication rates between patients with and without OSA. We also review the existing literature on this subject and make practical recommendations regarding pre-operative evaluation and post-operative management of these patients for practicing internists and surgeons based on the current literature.

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K. Nugent, M. Phy and R. Raj, "Obstructive Sleep Apnea and Post-Operative Complications: Single Center Data, Review of Literature and Guidelines for Practicing Internists and Surgeons," Surgical Science, Vol. 3 No. 2, 2012, pp. 65-71. doi: 10.4236/ss.2012.32012.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] T. Young, M. Palta, J. Dempsey, J. Skatrud, S. Weber and S. Badr, “The Occurrence of Sleep-Disordered Breathing among Middle-Aged Adults,” New England Journal of Medicine, Vol. 328, No. 17, 1993, pp. 1230-1235. doi:10.1056/NEJM199304293281704
[2] W. C. Frey and J. Pilcher, “Obstructive Sleep-Related Breathing Disorders in Patients Evaluated for Bariatric Surgery,” Obesity Surgery, Vol. 13, No. 5, 2003, pp. 676-683. doi:10.1381/096089203322509228
[3] R. M. Gupta, J. Parvizi, A. D. Hanssen and P. C. Gay, “Postoperative Complications in Patients with Obstructive Sleep Apnea Syndrome Undergoing Hip or Knee Replacement: A Case-Control Study,” Mayo Clinic Proceeding, Vol. 76, No. 9, 2001, pp. 897-905.
[4] R. Kaw, J. Golish, S. Ghamande, R. Burgess, N. Foldvary and E. Walker, “Incremental Risk of Obstructive Sleep Apnea on Cardiac Surgical Outcomes,” Journal of Cardiovascular Surgery (Torino), Vol. 47, No. 6, 2006, pp. 683-689.
[5] T. Mooe, S. Gullsby, T. Rabben and P. Eriksson, “Sleep-Disordered Breathing: A Novel Predictor of Atrial Fibrillation after Coronary Artery Bypass Surgery,” Coronary Artery Disease, Vol. 7, No. 6, 1996, pp. 475-478. doi:10.1097/00019501-199606000-00011
[6] H. Fidan, F. Fidan, M. Unlu, Y. Ela, A. Ibis and L. Tetik, “Prevalence of Sleep Apnoea in Patients Undergoing Operation,” Sleep Breath, Vol. 10, No. 3, 2006, pp. 161-165. doi:10.1007/s11325-006-0067-9
[7] R. S. Strauss and W. S. Browner, “Risk for Obstructive Sleep Apnea,” Annals of Internal Medicine, Vol. 132, No. 9, 2000, pp. 758-759.
[8] J. B. Gross, K. L. Bachenberg, J. L. Benumof, R. A. Caplan, R. T. Connis, C. J. Cote, D. G. Nickinovich, V. Prachand, D. S. Ward, E. M. Weaver, L. Ydens and S. Yu, “Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea: A Report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Obstructive Sleep Apnea,” Anesthesiology, Vol. 104, No. 5, 2006, pp. 1081-1093.
[9] F. Chung, B. Yegneswaran, P. Liao, S. A. Chung, S. Vairavanathan, S. Islam, A. Khajehdehi and C. M. Shapiro, “STOP Questionnaire: A Tool to Screen Patients for Obstructive Sleep Apnea,” Anesthesiology, Vol. 108, No. 5, 2008, pp. 812-821. doi:10.1097/ALN.0b013e31816d83e4
[10] F. Chung, B. Yegneswaran, P. Liao, S. A. Chung, S. Vairavanathan, S. Islam, A. Khajehdehi and C. M. Shapiro, “Validation of the Berlin Questionnaire and American Society of Anesthesiologists Checklist as Screening Tools for Obstructive Sleep Apnea in Surgical Patients,” Anesthesiology, Vol. 108, No. 5, 2008, pp. 822-830. doi:10.1097/ALN.0b013e31816d91b5
[11] “Practice Parameters for the Indications for Polysomnography and Related Procedures. Polysomnography Task Force, American Sleep Disorders Association Standards of Practice Committee,” Sleep, Vol. 20, No. 6, 1997, pp. 406-422.
[12] R. Kaw, V. Pasupuleti, E. Walker, A. Ramaswamy and N. Foldvary-Schafer, “Postoperative Complications in Patients with Obstructive Sleep Apnea,” Chest, 2011, PMID: 21868464.
[13] M. T. Rennotte, P. Baele, G. Aubert and D. O. Rodenstein, “Nasal Continuous Positive Airway Pressure in the Perioperative Management of Patients with Obstructive Sleep Apnea Submitted to Surgery,” Chest, Vol. 107, No. 2, 1995, pp. 367-374. doi:10.1378/chest.107.2.367
[14] S. Molliex, B. Dureuil, P. Montravers and J. M. Desmonts, “Effects of Midazolam on Respiratory Muscles in Humans,” Anesthesia & Analgesia, Vol. 77, No. 3, 1993, pp. 592-597. doi:10.1213/00000539-199309000-00029
[15] P. Montravers, B. Dureuil and J. M. Desmonts, “Effects of i.v. Midazolam on Upper Airway Resistance,” British Journal of Anaesthesia, Vol. 68, No. 1, 1992, pp. 27-31. doi:10.1093/bja/68.1.27
[16] D. M. Catley, C. Thornton, C. Jordan, J. R. Lehane, D. Royston and J. G. Jones, “Pronounced, Episodic Oxygen Desaturation in the Postoperative Period: Its Association with Ventilatory Pattern and Analgesic Regimen,” Anesthesiology, Vol. 63, No. 1, 1985, pp. 20-28. doi:10.1097/00000542-198507000-00004
[17] P. R. Eastwood, P. R. Platt, K. Shepherd, K. Maddison and D. R. Hillman, “Collapsibility of the Upper Airway at Different Concentrations of Propofol Anesthesia,” Anesthesiology, Vol. 103, No. 3, 2005, pp. 470-477. doi:10.1097/00000542-200509000-00007
[18] R. J. Schwab, K. B. Gupta, W. B. Gefter, L. J. Metzger, E. A. Hoffman and A. I. Pack, “Upper Airway and Soft Tissue Anatomy in Normal Subjects and Patients with Sleep-Disordered Breathing. Significance of the Lateral Pharyngeal Walls,” American Journal of Respiratory and Critical Care Medicine, Vol. 152, No. 5, 1995, pp. 1673- 1689.
[19] W. S. Mezzanotte, D. J. Tangel and D. P. White, “Influence of Sleep Onset on Upper-Airway Muscle Activity in Apnea Patients versus Normal Controls,” American Journal of Respiratory and Critical Care Medicine, Vol. 153, No. 6, 1996, pp. 1880-1887.
[20] L. Scrima, M. Broudy, K. N. Nay and M. A. Cohn, “Increased Severity of Obstructive Sleep Apnea after Bedtime Alcohol Ingestion: Diagnostic Potential and Proposed Mechanism of Action,” Sleep, Vol. 5, No. 4, 1982, pp. 318-328.
[21] L. A. Connolly, “Anesthetic Management of Obstructive Sleep Apnea Patients,” Journal of Clinical Anesthesia, Vol. 3, No. 6, 1991, pp. 461-469. doi:10.1016/0952-8180(91)90094-4
[22] J. G. Jones, C. Jordan, C. Scudder, D. A. Rocke and M. Barrowcliffe, “Episodic Postoperative Oxygen Desaturation: The Value of Added Oxygen,” Journal of the Royal Society of Medicine, Vol. 78, No. 12, 1985, pp. 1019-1022.
[23] M. A. Siyam and D. Benhamou, “Difficult Endotracheal Intubation in Patients with Sleep Apnea Syndrome,” Anesthesia & Analgesia, Vol. 95, No. 4, 2002, pp. 1098-1102.
[24] [24] C. Sabers, D. J. Plevak, D. R. Schroeder and D. O. Warner, “The Diagnosis of Obstructive Sleep Apnea as a Risk Factor for Unanticipated Admissions in Outpatient Surgery,” Anesthesia & Analgesia, Vol. 96, No. 5, 2003, pp. 1328-1335.
[25] D. J. Terris, E. F. Fincher, M. M. Hanasono, W. E. Fee Jr. and K. Adachi, “Conservation of Resources: Indications for Intensive Care Monitoring after Upper Airway Surgery on Patients with Obstructive Sleep Apnea,” Laryngoscope, Vol. 108, No. 6, 1998, pp. 784-788. doi:10.1097/00005537-199806000-00002
[26] E. M. Gessler and P. C. Bondy, “Respiratory Complications Following Tonsillectomy/UPPP: Is Step-Down Monitoring Necessary?” Ear, Nose and Throat Journal, Vol. 82, No. 8, 2003, pp. 628-632.
[27] K. Vidhani and B. T. Langham, “Obstructive Sleep Apnoea Syndrome: Is This an Overlooked Cause of Desaturation in the Immediate Postoperative Period?” British Journal of Anaesthesia, Vol. 78, No. 4, 1997, pp. 442-443.
[28] D. J. Cullen, “Obstructive Sleep Apnea and Postoperative Analgesia—A Potentially Dangerous Combination,” Journal of Clinical Anesthesia, Vol. 13, No. 2, 2001, pp. 83-85. doi:10.1016/S0952-8180(01)00261-6
[29] D. Hwang, N. Shakir, B. Limann, C. Sison, S. Kalra, L. Shulman, C. Souza Ade and H. Greenberg, “Association of Sleep-Disordered Breathing with Postoperative Complications,” Chest, Vol. 133, No. 5, 2008, pp. 1128-1134. doi:10.1378/chest.07-1488
[30] S. Memtsoudis, S. S. Liu, Y. Ma, Y. L. Chiu, J. M. Walz, L. K. Gaber-Baylis and M. Mazumdar, “Perioperative Pulmonary Outcomes in Patients with Sleep Apnea after Noncardiac Surgery,” Anesthesia & Analgesia, Vol. 112, No. 1, 2011, pp. 113-121. doi:10.1213/ANE.0b013e3182009abf
[31] S. A. Chung, H. Yuan and F. Chung, “A Systemic Review of Obstructive Sleep Apnea and Its Implications for Anesthesiologists,” Anesthesia & Analgesia, Vol. 107, No. 5, 2008, pp. 1543-1563. doi:10.1213/ane.0b013e318187c83a
[32] A. M. Ostermeier, M. F. Roizen, M. Hautkappe, P. A. Klock and J. M. Klafta, “Three Sudden Postoperative Respiratory Arrests Associated with Epidural Opioids in Patients with Sleep Apnea,” Anesthesia & Analgesia, Vol. 85, No. 2, 1997, pp. 452-460.
[33] M. K. Reeder, M. D. Goldman, L. Loh, A. D. Muir, K. R. Casey and D. A. Gitlin, “Postoperative Obstructive Sleep Apnoea. Haemodynamic Effects of Treatment with Nasal CPAP,” Anaesthesia, Vol. 46, No. 10, 1991, pp. 849-853. doi:10.1111/j.1365-2044.1991.tb09599.x
[34] C. Delclaux, E. L’Her, C. Alberti, J. Mancebo, F. Abroug, G. Conti, C. Guerin, F. Schortgen, Y. Lefort, M. Antonelli, E. Lepage, F. Lemaire and L. Brochard, “Treatment of Acute Hypoxemic Nonhypercapnic Respiratory Insufficiency with Continuous Positive Airway Pressure Deli-vered by a Face Mask: A Randomized Controlled Trial,” Journal of the American Medical Association, Vol. 284, No. 18, 2000, pp. 2352-2360. doi:10.1001/jama.284.18.2352
[35] G. B. Drummond, K. Stedul, R. Kingshott, K. Rees, A. F. Nimmo, P. Wraith and N. J. Douglas, “Automatic CPAP Compared with Conventional Treatment for Episodic Hypoxemia and Sleep Disturbance after Major Abdominal Surgery,” Anesthesiology, Vol. 96, No. 4, 2002, pp. 817-826. doi:10.1097/00000542-200204000-00007

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