obstructive sleep apnoea in the perioperative period

Obstructive Sleep Apnoea in the Perioperative Period

Dr. Tom Chambers

Dr. Tom Chambers

Anaesthetic trainee at NHS, North West London, England, United Kingdom. Clinical and Sleep Research Consultant at Sleepwave, London, United Kingdom. Honorary Clinical Fellow, Sleep & Ventilation at Barts Health NHS Trust. London, United Kingdom.

Dr. Tom Chambers, Anaesthetic trainee with a specialist interest in perioperative medicine and sleep medicine. Graduated from University College London with a distinction in his MBBS and is currently undertaking an MSc in Sleep Medicine from the University of Oxford. Since 2020, he has led on a project in a central London hospital to develop a perioperative diagnostic and treatment pathway for patients at high risk of undiagnosed obstructive sleep apnoea who are undergoing major surgery. Outputs from this project have been presented at multiple national and international conferences across 2023 winning awards from the London School of Anaesthesia, the Association of Anaesthetists, and the British Sleep Society. 

Undiagnosed Obstructive Sleep Apnoea in the Perioperative Period: A Growing Concern

For this Sleep Science Friday, we invited Dr. Chambers to highlight for us his recent research published in the paper “Perioperative management of Obstructive Sleep Apnoea: Present themes and future directions” (vide Chambers et al., 2023). In this review article, recent evidence on the optimum perioperative care for patients with obstructive sleep apnoea (OSA) is reviewed. Consideration is given to management of patients with diagnosed OSA and also to the ever-increasing number of patients with undiagnosed OSA who are undergoing surgery.  

Diagnosed OSA

Recent high-quality evidence has confirmed the risks of OSA around the time of an operation. A 2022 meta-analysis showed that patients with OSA are more than twice as likely to experience postoperative complications.  Fortunately, treatment with positive airways pressure (PAP) therapy can reduce these risks. 

In the run up to surgery, management of patients with OSA should focus on risk stratification based on disease severity, optimising adherence to PAP to reduce perioperative risks, and planning the safe anaesthesia for individual patients, for example through the use of regional techniques instead of general anaesthesia where appropriate. 

Undiagnosed OSA

With increasing prevalence of obesity, rates of OSA are also rising. Up to 80% of people with OSA in the population are currently undiagnosed. Hence, many patients with OSA presenting for surgery will not have a diagnosis. This increases their perioperative risk further as safe planning on how to manage their OSA cannot be implemented. 

The focus of this factsheet is on how to manage patients at risk of undiagnosed OSA. All patients presenting for surgery should be screened for possible OSA. There are a host of screening questionnaires available, and the most widely utilised and heavily researched is the STOPBang questionnaire. Once identified as high risk, in an ideal world all patients should undergo a sleep study to formally diagnose disease. There are many methods available to do this, each with pros and cons. Any diagnostic pathway should be in be minimally disruptive to the surgical timeline. 

Finally, if time permits once OSA is diagnosed, a period of PAP therapy should be initiated to reduce risks around surgery. High quality evidence is lacking on the optimum amount of time to initiate therapy before undergoing surgery, but it has been suggested that 4-6 weeks is ideal. Each patient needs to be reviewed on a case-by-case basis and the ability to diagnose and treat will depend on urgency of surgery, local facilities available, and individual patient factors.

For the full results and discussion of findings, you can read the full paper here.

Factsheet "Perioperative Care of Patients at Risk of Undiagnosed Obstructive Sleep Apnoea"

esrs infographic fact sheet perioperative care OSA obstructive sleep apnoea

Download the “Perioperative Care of Patients at Risk of Undiagnosed Obstructive Sleep Apnoea” factsheet in PDF format:

Article and factsheet based on:

Chambers et al.2023. Perioperative management of Obstructive Sleep Apnoea: Present themes and future directions. Curr Opin Pulm Med.

Factsheet designed by:

Dr. Maria Hrozanova

Dr. Maria Hrozanova

Postdoctoral fellow at the Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Norway, and a member of the ESRS Digital and Communication Committee.

Recent publications from ESRS members

  1. Riemann et al. (2023). The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023. J Sleep Res.
  2. Alakörkkö et al. (2023). The economic cost of obstructive sleep apnea: A systematic review. Sleep Med Rev.
  3. Buyse, Kalkanis and Testelmans. (2023). Catathrenia in severe obstructive sleep apnea: A novel entity never described before. Sleep Med.
  4. Wenz et al. (2023). Narcolepsy type 1 and Sydenham chorea – Report of 3 cases and review of the literature. Sleep Med.
  5. Chen et al. (2023). The association of insomnia with long COVID: An international collaborative study (ICOSS-II). Sleep Med.
  6. De Pieri et al. (2023). Central sleep apneas with Cheyne-Stokes breathing in a patient with narcolepsy type 1. Sleep Med.
  7. Kupferschmitt et al. (2023). Attention deficits and depressive symptoms improve differentially after rehabilitation of post-COVID condition – A prospective cohort study. J Psychosom Res.
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