Perioperative management of Patients with Obstructive Sleep Apnea

Main Article Content

Arnaud Romeo Mbadjeu Hondjeu
Frances Chung
Jean Wong


Obstructive sleep apnea, perioperative outcomes


Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing with up to 60% of surgical patients with moderate-to-severe OSA unrecognized at the time of preoperative assessment. OSA is a known modifier of perioperative outcomes, with an increase in difficult airway management and postoper-ative morbidity with early and late serious complications that may occasionally result in death. It is critical to identify at-risk patients during the preoperative period as it allows for risk stratification and mitigation, and postoperative monitoring. In this review, we will discuss the preoperative assessment, and intraoperative and postoperative management of patients with diagnosed or suspected OSA.

Le syndrome d'apnées obstructives du sommeil (SAOS) est la forme la plus frequente de troubles respira-toires du sommeil avec jusqu'à 60 % des patients chirurgicaux atteints de formes modérée à sévère de SAOS sans diagnostic formel ni traitement spécifique au moment de l'évaluation préopératoire. Le SAOS altère les résultats périopératoires, avec une augmentation de la gestion difficile des voies respiratoires et de la morbidité postopératoire associée à des complications critiques précoces et tardives pouvant parfois entraîner la mort. il est donc essentiel d'identifier les patients à risque pendant la période préopératoire enfin d'appliquer des procédures de modération de risque, ainsi que des précautions et une surveillance adéquates. Dans cette revue, après un aperçu de la physiopathologie du SAOS, nous discuterons de l'évaluation préopératoire, de la prise en charge intraopératoire et postopératoire des patients atteints de SAOS confirmée ou suspectée.

Abstract 205 | PDF Downloads 127 XML Downloads 39 HTML Downloads 463


1. Memtsoudis S, Cozowicz C, Nagappa M, Wong J, Joshi GP, Wong DT, et al. Society of anesthesia and sleep medicine guideline on intraoperative management of adult patients with obstructive sleep apnea. Anesth Analg. 2018;(127):967–87.
2. Gross JB, Apfelbaum JL, Caplan RA, Connis RT, Cote CJ, Nickinovich DG, et al. Practice guidelines for the perioperative management of patients with obstructive sleep apnea an updated report by the American society of anesthesiologists task force on perioperative management of patients with obstructive sleep apnea. Anesthesiology. 2014;120(2):268–86.
3. Joshi GP, Ankichetty SP, Gan TJ, Chung F. Society for Ambulatory Anesthesia consensus statement on preoperative selection of adult patients with obstructive sleep apnea scheduled for ambulatory surgery. Anesth Analg. 2012;115(5):1060–8.
4. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006–14.
5. Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, et al. Prevalence of sleep-disordered breathing in the general population: The HypnoLaus study. Lancet Respir Med. 2015;3(4):310–8.
6. Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MS, Morrell MJ, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: A literature-based analysis. Lancet Respir Med. 2019;7(8):687–98.
7. Redline S, Sotres-Alvarez D, Loredo J, Hall M, Patel SR, Ramos A, et al. Sleep-disordered breathing in Hispanic/Latino individuals of diverse backgrounds. The Hispanic community health study/study of Latinos. Am J Respir Crit Care Med. 2014;189(3):335–44.
8. Finkel KJ, Searleman AC, Tymkew H, Tanaka CY, Saager L, Safer-Zadeh E, et al. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med. 2009;10(7):753–8.
9. Lechner M, Breeze CE, Ohayon MM, Kotecha B. Snoring and breathing pauses during sleep: Interview survey of a United Kingdom population sample reveals a significant increase in the rates of sleep apnoea and obesity over the last 20 years-data from the UK sleep survey. Sleep Med. 2019;54:250–6.
10. Redline S, Tishler PV, Hans MG, Tosteson TD, Strohl KP, Spry K. Racial differences in sleep-disordered breathing in African–Americans and Caucasians. Am J Respir Crit Care Med. 1997;155(1):186–92.
11. Lee W, Nagubadi S, Kryger MH, Mokhlesi B. Epidemiology of obstructive sleep apnea: A population-based perspective. Expert Rev Respir Med. 2008;2(3):349–64.
12. Ip MS, Lam B, Lauder IJ, Tsang KW, Chung K, Mok Y, et al. A community study of sleep-disordered breathing in middle-aged Chinese men in Hong Kong. Chest. 2001;119(1):62–9.
13. Ishikawa Y, Ishikawa J, Ishikawa S, Kayaba K, Nakamura Y, Shimada K, et al. The Asia-Pacific perspective: Redefining obesity and its treatment. Melbourne, 2000.
14. Singh M, Liao P, Kobah S, Wijeysundera D, Shapiro C, Chung F. Proportion of surgical patients with undiagnosed obstructive sleep apnoea. Br J Anaesth. 2013;110(4):629–36.
15. Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg. 2003;13(5):676–83.
16. O’keeffe T, Patterson EJ. Evidence supporting routine polysomnography before bariatric surgery. Obes Surg. 2004;14(1):23–6.
17. Chan MT, Wang CY, Seet E, Tam S, Lai HY, Chew EF, et al. Association of unrecognized obstructive sleep apnea with postoperative cardiovascular events in patients undergoing major noncardiac surgery. JAMA. 2019;321(18):1788–98.
18. Kaw R, Chung F, Pasupuleti V, Mehta J, Gay P, Hernández AV. Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome. Br J Anaesth. 2012;109(6):897–906.
19. Nagappa M, Patra J, Wong J, Subramani Y, Singh M, Ho G, et al. Association of STOP-Bang questionnaire as a screening tool for sleep apnea and postoperative complications: A systematic review and bayesian meta-analysis of prospective and retrospective cohort studies. Anesth Analg. 2017;125(4):1301–8.
20. Opperer M, Cozowicz C, Bugada D, Mokhlesi B, Kaw R, Auckley D, et al. Does obstructive sleep apnea influence perioperative outcome? A qualitative systematic review for the Society of Anesthesia and Sleep Medicine Task Force on preoperative preparation of patients with sleep-disordered breathing. Anesth Analg. 2016;122(5):1321–34.
21. Bolden N, Posner KL, Domino KB, Auckley D, Benumof JL, Herway ST, et al. Postoperative critical events associated with obstructive sleep apnea: Results from the society of anesthesia and sleep medicine obstructive sleep apnea registry. Anesth Analg. 2020;131(4):1032–41.
22. Jenkinson C, Davies RJ, Mullins R, Stradling JR. Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: A randomised prospective parallel trial. Lancet. 1999;353(9170):2100–5.
23. Arzt M, Young T, Finn L, Skatrud JB, Bradley TD. Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med. 2005;172(11):1447–51.
24. Gami AS, Howard DE, Olson EJ, Somers VK. Day–night pattern of sudden death in obstructive sleep apnea. N Engl J Med. 2005;352(12):1206–14.
25. 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(4):1319–26.
26. Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP. Pathophysiology of sleep apnea. Physiol Rev. 2010;90(1):47–112.
27. Schwab RJ, Gupta KB, Gefter WB, Metzger LJ, Hoffman EA, Pack AI. Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. Am J Respir Crit Care Med. 1995;152(5):1673–89.
28. Pevernagie DA, Stanson A, Sheedy 2nd P, Daniels BK, Shepard Jr JW. Effects of body position on the upper airway of patients with obstructive sleep apnea. Am J Respir Crit Care Med. 1995;152(1):179–85.
29. Tsuiki S, Isono S, Ishikawa T, Yamashiro Y, Tatsumi K, Nishino T. Anatomical balance of the upper airway and obstructive sleep apnea. J Am Soc Anesthesiol. 2008;108(6):1009–15.
30. Redolfi S, Yumino D, Ruttanaumpawan P, Yau B, Su M-C, Lam J, et al. Relationship between overnight rostral fluid shift and obstructive sleep apnea in nonobese men. Am J Respir Crit Care Med. 2009;179(3):241–6.
31. Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, et al. Sleep apnea and cardiovascular disease: An American Heart Association/American College of Cardiology Foundation scientific statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing in collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institute of Health). J Am Coll Cardiol. 2008;52(8):686–717.
32. Briançon-Marjollet A, Weiszenstein M, Henri M, Thomas A, Godin-Ribuot D, Polak J. The impact of sleep disorders on glucose metabolism: Endocrine and molecular mechanisms. Diabetol Metab Syndr. 2015;7(1):1–16.
33. Subramani Y, Singh M, Wong J, Kushida CA, Malhotra A, Chung F. Understanding phenotypes of obstructive sleep apnea: Applications in anesthesia, surgery, and perioperative medicine. Anesth Analg. 2017;124(1):179.
34. Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A. Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med. 2013;188(8):996–1004.
35. Aishah A, Eckert DJ. Phenotypic approach to pharmacotherapy in the management of obstructive sleep apnoea. Curr Opin Pulm Med. 2019;25(6):594–601.
36. Gray EL, McKenzie DK, Eckert DJ. Obstructive sleep apnea without obesity is common and difficult to treat: Evidence for a distinct pathophysiological phenotype. J Clin Sleep Med. 2017;13(1):81–8.
37. Younes M, Ostrowski M, Atkar R, Laprairie J, Siemens A, Hanly P. Mechanisms of breathing instability in patients with obstructive sleep apnea. J Appl Physiol. 2007;103(6):1929–41.
38. Mir S, Wong J, Ryan CM, Bellingham G, Singh M, Waseem R, et al. Concomitant benzodiazepine and opioids decrease sleep apnoea risk in chronic pain patients. ERJ Open Res. 2020;6(3):00093–2020.
39. Eckert DJ, Owens RL, Kehlmann GB, Wellman A, Rahangdale S, Yim-Yeh S, et al. Eszopiclone increases the respiratory arousal threshold and lowers the apnoea/hypopnoea index in obstructive sleep apnoea patients with a low arousal threshold. Clin Sci. 2011;120(12):505–14.
40. Altree TJ, Chung F, Chan MT, Eckert DJ. Vulnerability to postoperative complications in obstructive sleep apnea: Importance of phenotypes. Anesth Analg. 2021;132(5):1328–37.
41. Sands SA, Edwards BA, Terrill PI, Taranto-Montemurro L, Azarbarzin A, Marques M, et al. Phenotyping pharyngeal pathophysiology using polysomnography in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 2018;197(9):1187–97.
42. Messineo L, Taranto‐Montemurro L, Azarbarzin A, Oliveira Marques MD, Calianese N, White DP, et al. Breath‐holding as a means to estimate the loop gain contribution to obstructive sleep apnoea. J Physiol. 2018;596(17):4043–56.
43. Chung F, Memtsoudis SG, Ramachandran SK, Nagappa M, Opperer M, Cozowicz C, et al. Society of anesthesia and sleep medicine guidelines on preoperative screening and assessment of adult patients with obstructive sleep apnea. Anesth Analg. 2016;123(2):452.
44. Chung F, Liao P, Farney R. Correlation between the STOP-Bang score and the severity of obstructive sleep apnea. Anesthesiology. 2015;122(6):1436–7.
45. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. STOP questionnaire: A tool to screen patients for obstructive sleep apnea. J Am Soc Anesthesiol. 2008;108(5):812–21.
46. Nagappa M, Liao P, Wong J, Auckley D, Ramachandran SK, Memtsoudis S, et al. Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea among different populations: A systematic review and meta-analysis. PLoS One. 2015;10(12):e0143697.
47. Nagappa M, Wong J, Singh M, Wong DT, Chung F. An update on the various practical applications of the STOP-Bang questionnaire in anesthesia, surgery, and perioperative medicine. Curr Opin Anaesthesiol. 2017;30(1):118.
48. Seet E, Chua M, Liaw CM. High STOP-BANG questionnaire scores predict intraoperative and early postoperative adverse events. Singapore Med J. 2015;56(4):212.
49. Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: An American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(3):479–504.
50. Vaughn BV, Giallanza P. Technical review of polysomnography. Chest. 2008;134(6):1310–9.
51. Jonas DE, Amick HR, Feltner C, Weber RP, Arvanitis M, Stine A, et al. Screening for obstructive sleep apnea in adults: Evidence report and systematic review for the US Preventive Services Task Force. Jama. 2017;317(4):415–33.
52. Saletu MT, Kotzian ST, Schwarzinger A, Haider S, Spatt J, Saletu B. Home sleep apnea testing is a feasible and accurate method to diagnose obstructive sleep apnea in stroke patients during in-hospital rehabilitation. J Clin Sleep Med. 2018;14(9):1495–501.
53. Szeto B, Vertosick EA, Ruiz K, Tokita H, Vickers A, Assel M, et al. Outcomes and safety among patients with obstructive sleep apnea (OSA) undergoing cancer surgery procedures in a free-standing ambulatory surgical facility. Anesth Analg. 2019;129(2):360.
54. Rosero EB, Joshi GP. Outcomes of sleep apnea surgery in outpatient and inpatient settings. Anesth Analg. 2021;132(5):1215–22.
55. Ravesloot MJ, De Raaff CA, Van De Beek MJ, Benoist LB, Beyers J, Corso RM, et al. Perioperative care of patients with obstructive sleep apnea undergoing upper airway surgery: A review and consensus recommendations. JAMA Otolaryngol Neck Surg. 2019;145(8):751–60.
56. Mutter TC, Chateau D, Moffatt M, Ramsey C, Roos LL, Kryger M. A matched cohort study of postoperative outcomes in obstructive sleep apnea: Could preoperative diagnosis and treatment prevent complications? Anesthesiology. 2014;121(4):707–18.
57. Abdelsattar ZM, Hendren S, Wong SL, Campbell Jr DA, Ramachandran SK. The impact of untreated obstructive sleep apnea on cardiopulmonary complications in general and vascular surgery: A cohort study. Sleep. 2015;38(8):1205–10.
58. Nagappa M, Mokhlesi B, Wong J, Wong DT, Kaw R, Chung F. The effects of continuous positive airway pressure on postoperative outcomes in obstructive sleep apnea patients undergoing surgery: A systematic review and meta-analysis. Anesth Analg. 2015;120(5):1013–23.
59. Ramakrishna G, Sprung J, Ravi BS, Chandrasekaran K, McGoon MD. Impact of pulmonary hypertension on the outcomes of noncardiac surgery: Predictors of perioperative morbidity and mortality. J Am Coll Cardiol. 2005;45(10):1691–9.
60. Kaw R, Bhateja P, y Mar HP, Hernandez AV, Ramaswamy A, Deshpande A, et al. Postoperative complications in patients with unrecognized obesity hypoventilation syndrome undergoing elective noncardiac surgery. Chest. 2016;149(1):84–91.
61. Chung F, Zhou L, Liao P. Parameters from preoperative overnight oximetry predict postoperative adverse events. Minerva Anestesiol. 2014;80(10):1084–95.
62. Meoli A, Rosen C, Kristo D, Kohrman M, Gooneratne N, Aguillard R. Clinical Practice Review Committee American Academy of Sleep Medicine. Upper airway management of the adult patient with obstructive sleep apnea in the perioperative period: Avoiding complications. Sleep. 2003;26:1060–5.
63. Nagappa M, Wong DT, Cozowicz C, Ramachandran SK, Memtsoudis SG, Chung F. Is obstructive sleep apnea associated with difficult airway? Evidence from a systematic review and meta-analysis of prospective and retrospective cohort studies. PLoS One. 2018;13(10):e0204904.
64. Benumof JL. Obesity, sleep apnea, the airway and anesthesia. Curr Opin Anesthesiol. 2004;17(1):21–30.
65. Isono S, Warner DS, Warner MA. Obstructive sleep apnea of obese adults: Pathophysiology and perioperative airway management. J Am Soc Anesthesiol. 2009;110(4):908–21.
66. Seet E, Chung F. Management of sleep apnea in adults-functional algorithms for the perioperative period: Continuing professional development. Can J Anesth Can Anesth. 2010;57(9):849–64.
67. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: An updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118(2):251–70.
68. Seet E, Nagappa M, Wong DT. Airway management in surgical patients with obstructive sleep apnea. Anesth Analg. 2021;132(5):1321–7.
69. Wong DT, Dallaire A, Singh KP, Madhusudan P, Jackson T, Singh M, et al. High-flow nasal oxygen improves safe apnea time in morbidly obese patients undergoing general anesthesia: A randomized controlled trial. Anesth Analg. 2019;129(4):1130–6.
70. Deegan PC, Mulloy E, McNicholas WT. Topical oropharyngeal anesthesia in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 1995;151(4):1108–12.
71. Hillman DR, Chung F. Anaesthetic management of sleep‐disordered breathing in adults. Respirology. 2017;22(2):230–9.
72. Eastwood PR, Platt PR, Shepherd K, Maddison K, Hillman DR. Collapsibility of the upper airway at different concentrations of propofol anesthesia. J Am Soc Anesthesiol. 2005;103(3):470–7.
73. Hutchison R, Rodriguez L. Capnography and respiratory depression. AJN Am J Nurs. 2008;108(2):35–9.
74. Friedrich-Rust M, Welte M, Welte C, Albert J, Meckbach Y, Herrmann E, et al. Capnographic monitoring of propofol-based sedation during colonoscopy. Endoscopy. 2014;46(03):236–44.
75. Memtsoudis SG, Stundner O, Rasul R, Sun X, Chiu Y-L, Fleischut P, et al. Sleep apnea and total joint arthroplasty under various types of anesthesia: A population-based study of perioperative outcomes. Reg Anesth Pain Med. 2013;38(4):274–81.
76. Naqvi SY, Rabiei AH, Maltenfort MG, Restrepo C, Viscusi ER, Parvizi J, et al. Perioperative complications in patients with sleep apnea undergoing total joint arthroplasty. J Arthroplasty. 2017;32(9):2680–3.
77. Chung F, Liao P, Yegneswaran B, Shapiro CM, Kang W. Postoperative changes in sleep-disordered breathing and sleep architecture in patients with obstructive sleep apnea. Anesthesiology. 2014;120(2):287–98.
78. Fouladpour N, Jesudoss R, Bolden N, Shaman Z, Auckley D. Perioperative complications in obstructive sleep apnea patients undergoing surgery: A review of the legal literature. Anesth Analg. 2016;122(1):145–51.
79. Hafeez KR, Tuteja A, Singh M, Wong DT, Nagappa M, Chung F, et al. Postoperative complications with neuromuscular blocking drugs and/or reversal agents in obstructive sleep apnea patients: A systematic review. BMC Anesthesiol. 2018;18(1):1–11.
80. Meng T, Zhong Z, Meng L. Impact of spinal anaesthesia vs. general anaesthesia on peri‐operative outcome in lumbar spine surgery: A systematic review and meta‐analysis of randomised, controlled trials. Anaesthesia. 2017;72(3):391–401.
81. Macfarlane AJ, Prasad GA, Chan VW, Brull R. Does regional anesthesia improve outcome after total knee arthroplasty? Clin Orthop Relat Res. 2009;467(9):2379–402.
82. Gan TJ. Poorly controlled postoperative pain: Prevalence, consequences, and prevention. J Pain Res. 2017;10:2287.
83. Gupta K, Nagappa M, Prasad A, Abrahamyan L, Wong J, Weingarten TN, et al. Risk factors for opioid-induced respiratory depression in surgical patients: A systematic review and meta-analyses. BMJ Open. 2018;8(12):e024086.
84. Doufas AG, Tian L, Davies MF, Warby SC. Nocturnal intermittent hypoxia is independently associated with pain in subjects suffering from sleep-disordered breathing. Anesthesiology. 2013;119(5):1149–62.
85. Turan A, You J, Egan C, Fu A, Khanna A, Eshraghi Y, et al. Chronic intermittent hypoxia is independently associated with reduced postoperative opioid consumption in bariatric patients suffering from sleep-disordered breathing. PLoS One. 2015;10(5):e0127809.
86. Blake D, Yew C, Donnan G, Williams D. Postoperative analgesia and respiratory events in patients with symptoms of obstructive sleep apnoea. Anaesth Intensive Care. 2009;37(5):720–5.
87. Kehlet H, Werner MU. Role of paracetamol in the acute pain management. Drugs. 2003;63:15–22.
88. Ong CK, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: A qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg. 2010;110(4):1170–9.
89. Wickerts L, Brattwall M, Jakobsson J. Coxibs: Is there a benefit when compared to traditional non-selective NSAIDs in postoperative pain management? Minerva Anestesiol. 2011;77(11):1084–98.
90. Waldron N, Jones C, Gan T, Allen T, Habib A. Impact of perioperative dexamethasone on postoperative analgesia and side-effects: Systematic review and meta-analysis. Br J Anaesth. 2013;110(2):191–200.
91. Albrecht E, Kern C, Kirkham K. A systematic review and meta‐analysis of perineural dexamethasone for peripheral nerve blocks. Anaesthesia. 2015;70(1):71–83.
92. Cozowicz C, Chung F, Doufas AG, Nagappa M, Memtsoudis SG. Opioids for acute pain management in patients with obstructive sleep apnea: A systematic review. Anesth Analg. 2018;127(4):988–1001.
93. American Society of Anesthesiologists Task Force on Neuraxial Opioids. Practice guidelines for the prevention, detection, and management of respiratory depression associated with neuraxial opioid administration. J Am Soc Anesthesiol. 2009;110(2):218–30.
94. Cavalcante AN, Sprung J, Schroeder DR, Weingarten TN. Multimodal analgesic therapy with gabapentin and its association with postoperative respiratory depression. Anesth Analg. 2017;125(1):141–6.
95. Weingarten TN, Jacob AK, Njathi CW, Wilson GA, Sprung J. Multimodal analgesic protocol and postanesthesia respiratory depression during phase I recovery after total joint arthroplasty. Reg Anesth Pain Med. 2015;40(4):330–6.
96. Neill AM, Angus SM, Sajkov D, McEVOY RD. Effects of sleep posture on upper airway stability in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 1997;155(1):199–204.
97. Penzel T, Möller M, Becker HF, Knaack L, Peter J-H. Effect of sleep position and sleep stage on the collapsibility of the upper airways in patients with sleep apnea. Sleep. 2001;24(1):90–5.
98. Chung SA, Yuan H, Chung F. A systemic review of obstructive sleep apnea and its implications for anesthesiologists. Anesth Analg. 2008;107(5):1543–63.
99. Lam T, Singh M, Yadollahi A, Chung F. Is perioperative fluid and salt balance a contributing factor in postoperative worsening of obstructive sleep apnea? Anesth Analg. 2016;122(5):1335–9.
100. Isono S, Tanaka A, Nishino T. Lateral position decreases collapsibility of the passive pharynx in patients with obstructive sleep apnea. J Am Soc Anesthesiol. 2002;97(4):780–5.
101. Liao P, Wong J, Singh M, Wong DT, Islam S, Andrawes M, et al. Postoperative oxygen therapy in patients with OSA: A randomized controlled trial. Chest. 2017;151(3):597–611.
102. Liao P, Luo Q, Elsaid H, Kang W, Shapiro CM, Chung F. Perioperative auto-titrated continuous positive airway pressure treatment in surgical patients with obstructive sleep apnea: A randomized controlled trial. Anesthesiology. 2013;119(4):837–47.
103. Suen C, Wong J, Warsame K, Subramani Y, Panzarella T, Waseem R, et al. Perioperative adherence to continuous positive airway pressure and its effect on postoperative nocturnal hypoxemia in obstructive sleep apnea patients: A prospective cohort study. BMC Anesthesiol. 2021;21(1):1–10.
104. O’Gorman SM, Gay PC, Morgenthaler TI. Does autotitrating positive airway pressure therapy improve postoperative outcome in patients at risk for obstructive sleep apnea syndrome?: A randomized controlled clinical trial. Chest. 2013;144(1):72–8.
105. Gali B, Whalen FX, Schroeder DR, Gay PC, Plevak DJ. Identification of patients at risk for postoperative respiratory complications using a preoperative obstructive sleep apnea screening tool and postanesthesia care assessment. J Am Soc Anesthesiol. 2009;110(4):869–77.
106. Khanna AK, Bergese SD, Jungquist CR, Morimatsu H, Uezono S, Lee S, et al. Prediction of opioid-induced respiratory depression on inpatient wards using continuous capnography and oximetry: An international prospective, observational trial. Anesth Analg. 2020;131(4):1012.
107. Subramani Y, Nagappa M, Wong J, Patra J, Chung F. Death or near-death in patients with obstructive sleep apnoea: A compendium of case reports of critical complications. Br J Anaesth. 2017;119(5):885–99.
108. Lee LA, Caplan RA, Stephens LS, Posner KL, Terman GW, Voepel-Lewis T, et al. Postoperative opioid-induced respiratory depression: A closed claims analysis. Anesthesiology. 2015;122(3):659–65.
109. Chung F, Wong J, Mestek ML, Niebel KH, Lichtenthal P. Characterization of respiratory compromise and the potential clinical utility of capnography in the post-anesthesia care unit: A blinded observational trial. J Clin Monit Comput. 2020;34(3):541–51.

Similar Articles

You may also start an advanced similarity search for this article.