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March 2004
Volume 68 |
Number 3 |
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Practice Parameters/Sleep Apnea: New Task Force Dreams
of Defeating Growing Condition Michael
F. Roizen, M.D.
Motivated by ASA members’ concerns and questions,
the topic of sleep apnea will be the focus of a new
practice parameter effort of your ASA.
Twenty-five years ago, sleep apnea was not mentioned
in the classic anesthesiology textbooks. At that time,
less than 15 percent of the U.S. population was considered
obese; 15 percent of Americans had a body mass index
(BMI) of 25 or above. In the short period of 25 years,
however, more than 60 percent of people in the U.S.
have a BMI of 27 or above. In every state in the nation
except Colorado, more than 20 percent of its entire
population now has a BMI of 30.1 or above.
This increase in obesity has brought with it an increase
in obstructive sleep apnea. We have gone from a nation
with rare cases of nonobstructive sleep apnea (present
in less than 1 in 2,000 people) to having 5 percent
of men over the age of 50 and 3 percent of women in
that age group potentially having obstructive sleep
apnea.
This increase in incidents of sleep apnea has brought
an increased complexity in anesthesia perioperative
management, including recovery, and even in noninvasive
procedures when pain medication is needed. These difficulties
have been highlighted in the literature in cases of
sudden postoperative cardiac arrest. Sleep apnea is
increasingly frequent as a cause of lawsuit. There
is concern as to whether there are enough data in
the literature to inform us about how to deal with
these situations appropriately.
Knowledge of the condition and the added responsibility
it brings will be part of the foci of this new practice
parameter effort on anesthesia and sleep apnea.
The recently created Task Force on Perioperative Management
of Patients With Sleep Apnea meets under the leadership
of James F. Arens, M.D., chair of the Committee on
Practice Parameters, and will be chaired by Jeffrey
B. Gross, M.D., of the University of Connecticut,
Farmington, Connecticut. As with all practice parameter
task forces, it will include input from one or two
experts in the field. In this case, experts on sleep
apnea and bariatric and ear, nose and throat surgery
will act as consultants to the committee. About half
of the task force members are private practitioners,
and half are academic anesthesiologists.
An open forum at the ASA Annual Meeting or other large
gathering of anesthesiologists will be used to seek
your input. Further developments will be announced
on the ASA Web site.
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Michael
F. Roizen, M.D., is Professor of Anesthesiology
and Professor of Medicine, SUNY Upstate Medical
Center, Syracuse, New York. |
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