Perioperative complications in obstructive sleep apnea patients.

BACKGROUND: Perioperative complications in obstructive sleep apnea (OSA) patients are described in a small series of case reports. No study to date systematically evaluates perioperative complications in a large number of OSA patients receiving surgeries other than those involving the pharynx.

METHODS: Names of the 860 OSA patients seen in a hospital-based sleep disorders center was cross-referenced with a list of the names of the 2,350 patients receiving surgeries in hospital during an 18 month period. In-patient and sleep center records of the 57 OSA patients receiving surgery were reviewed.

RESULTS: Nine perioperative complications occurred in eight of 48 OSA patients (17%) receiving general anesthesia. All of these complications were related to difficulties with airway management both pre- and postoperatively. Clinical characteristics including body mass index and Polysomnographie measurements of OSA severity did not prove to be useful predictors of perioperative complications.

CONCLUSIONS: The incidence of respiratory complications related to difficulties in airway management in OSA patients was higher than that reported in a recent study for all patients receiving general anesthesia (4%). The perioperative complications observed in these OSA patients are consistent with the underlying pathogenesis of OSA, pharyngeal obstruction. The absence of observed perioperative arrhythmias and myocardial ischemia is consistent with previous findings that sleep-related cardiac ischemia is uncommon in OSA patients. Our results suggest it is prudent to cautiously manage all OSA patients receiving surgeries involving general anesthesia.