Perioperative management of obstructive sleep apnea: a survey of Puerto Rico anesthesia providers.

BACKGROUND: Obstructive sleep apnea (OSA) prevalence has been increasing in the past years adding significant morbidity. Perioperative management is controversial and few studies have addressed this matter. The American Society of Anesthesiology (ASA) and the American Academy of Sleep Medicine (AASM) have developed clinical practice guidelines for the perioperative management of patients with OSA. Existing evidence suggest an increase in early postoperative complications in patients with OSA. Nevertheless, data about perioperative management of OSA is limited. To our knowledge, only two studies that address this matter, none in Puerto Rico.

METHODS: A questionnaire was given to participants at the annual meeting of anesthesiology in Puerto Rico. The document was then anonymously deposited into sealed box.

RESULTS: The response rate was 80 %. The awareness about written postoperative policy in patients with diagnosed (23 %) and suspected (11 %) OSA was low. If a written policy were available, 46 % of patients would have gone to ICU. The most important factor for final disposition was the degree of OSA, which was decided by surgery and anesthesia (69 %). In the last year, at least one complication related to OSA was observed in 20 % of respondents. The most common preoperative screening tool was the ASA guidelines. Seventy-two percent of respondents suggested a lack of institutional policies as the main reason for disparity.

CONCLUSION: There is a significant heterogeneity in the current clinical practice. The main barriers identified to achieve current recommendations were lack of institutional policies, awareness of current guideline, formal training in management of OSA, and access to a sleep specialist.