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FOR RELEASE: Immediately
May 4, 2006
CONTACT:
Gina A. Steiner
Donna E. Habich
(847) 825-5586

 

Wake Up to Potential Dangers of Obstructive Sleep Apnea

CHICAGO—An alarming number of Americans experience a physical condition that can do more than just interrupt sleep.  If undetected, it can lead to serious health problems and result in complications before, during and after surgery.  It is called obstructive sleep apnea.

The May issue of the journal Anesthesiology features new “Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea”  from the American Society of Anesthesiologists (ASA).  The guidelines were developed by an ASA task force to assist its members in offering safe and informed patient care relating to this condition.

Obstructive sleep apnea occurs when the soft tissue in the back of the throat narrows and repeatedly closes during sleep.  The brain responds to each of these “apnea events” by waking the person in order to resume breathing.  These events can occur many times each night, resulting in interrupted and ineffective sleep. 

ASA President Orin F. Guidry, M.D., said, “The incidence of obstructive sleep apnea is likely to rise as the population ages and becomes more obese.” He added, “This will result in greater potential for surgical complications in patients requiring sedation or anesthesia.”  Dr. Guidry explained that ASA felt it was important to provide guidelines that will aid anesthesiologists, as well as other physicians and medical personnel involved in the care of sleep apnea patients, in identifying and addressing potential complications. 

An estimated 18 million Americans are thought to have obstructive sleep apnea.  Of those, approximately 16 million remain undiagnosed.  Without proper treatment, the condition can cause high blood pressure, cardiac disease, impotence, and behavior and cognitive problems. Sleep apnea may be responsible for many job-related injuries and it is estimated that people with sleep apnea are 10 times more likely to die in a car accident than someone without sleep apnea.

Anesthesiologists are trained to provide immediate airway management during general anesthesia and sedation, but patients can help by telling them about their sleep apnea when asked for their health history. 

Precautions that will minimize or anticipate the possibility of complications can then be taken before, during and after the surgery.  Patients should also ask their anesthesiologist and other health care providers about any questions or concerns they may have regarding their sleep apnea and surgery.  
 
Recommendations developed by the ASA task force for each of the surgical stages include: 

  • Preoperative Evaluation: Anesthesiologists should work with surgeons to develop a protocol whereby patients in whom the possibility of obstructive sleep apnea is suspected on clinical grounds are evaluated long enough before the day of surgery to allow preparation of a perioperative management plan.
     
  • Preoperative Preparation: Preoperative initiation of Continuous Positive Airway Pressure (CPAP) should be considered, particularly if obstructive sleep apnea is severe.
  • Intraoperative Management: Because of their propensity for airway collapse and sleep deprivation, patients with obstructive sleep apnea are especially susceptible to the respiratory depressant and airway effects of sedatives, narcotics and inhaled anesthetics.  Therefore, in selecting intraoperative medications, the potential for postoperative respiratory compromise should be considered.
  • Postoperative Management: Regional analgesic (pain relief) techniques should be considered to reduce or eliminate the requirement for systemic opioids (narcotics) in patients at increased perioperative risk from obstructive sleep apnea.
  • Inpatient vs. Outpatient Surgery and Criteria for Discharge to Unmonitored Settings: Before patients at increased perioperative risk from OSA are scheduled for surgery, a determination should be made regarding whether a given surgical procedure is most appropriately performed on an in- patient or out-patient basis.  In addition, specific criteria should be met for discharging the patient after surgery to an unmonitored setting, such as home.

   
To determine if you may have obstructive sleep apnea, ask yourself the following questions:

Have I been told I snore or stop breathing during sleep?
Do I wake up throughout the night or constantly turn from side to side?
Am I told my legs or arms jerk while sleeping?
Do I make abrupt snorting noises during sleep?
Do I feel tired or fall asleep during the day?

If your answer is “yes” to any of these questions, you may have obstructive sleep apnea.  The condition can be treated in a variety of ways, so it is important that you discuss your symptoms with your doctor, especially if you are facing the prospect of surgery.

For more information, and for questions to ask about obstructive sleep apnea and surgery, see the ASA publication “Feeling Tired?  But You’re Not Sure Why?” at <http://www.asahq.org/patientEducation/apnea.htm>

The American Society of Anesthesiologists (ASA) is a 41,000 member educational and professional organization representing medically trained anesthesiologists. As physicians, anesthesiologists have the most advanced education and training of any anesthesia professional and are responsible for the safe delivery of over 90% of all anesthetics provided in the United States.  Outside of the operating room, anesthesiologists are often found treating patients in pain clinics and delivering critical medical care to patients in hospital intensive care units, emergency rooms and diagnostic facilities.
Visit our Web site at <http://www.asahq.org>



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