Perioperative Monitoring of Patients with Obstructive Sleep Apnea Syndrome-Juniper Publishers
Juniper Publishers-Journal of Anesthesia
Abstract
Recognition of patients with Obstructive Sleep Apnea
Syndrome (OSAS) in Perioperative period by medical staff is important in
terms of preventing complications related to OSAS. As well as pulmonary
hypertension, coronary artery disease, hypertension, heart failure,
arrhythmia, stroke, and myocardial infarction can be regarded among
complications caused by OSAS. All these complications increase morbidity
and mortality of OSAS. The gold standard of OSAS is polysomnography. In
the literature, it is known that, apart from patients who can be
diagnosed with polysomnography; there are patients with OSAS who are not
diagnosed yet. These patients pose risk in Perioperative period because
they are not diagnosed. Diagnosing patients with additional health
problems such as OSAS which can put patients' life in danger in the
Perioperative period is important in terms of preventing unnecessary
complications in intraoperative, postoperative periods, and providing
early diagnosis and treatment. In this article prepared based on the
literature, it was aimed to present the importance of recognition of
patients with Obstructive Sleep Apnea in Perioperative period [1].
Keywords: Obstructive Sleep Apnea Syndrome; Surgery; Postoperative complicationIntroduction
Obstructive Sleep Apnea Syndrome (OSAS) comprises the
most important group of sleep-disordered breathing! OSAS is a breathing
effort shown against full or partial airway obstruction. And, developed
apnea is over with a loud snoring or arousal when airway is ensured
again. It has been reported that OSAS is a more common disease compared
to asthma and diabetes mellitus among adults. The main factors that
increase the risk of OSAS are age, sex, genetic characteristics, being
fat, neck circumference (short and thick neck), and craniofacial
anomalies, use of hypnotic drugs, cigarette and alcohol [2].
The most distinct three symptoms observed in patients
with OSAS are extreme snoring at night, apnea, and daytime sleepinessl.
Moreover, sudden awakening with the drowning sensation and apnea
symptoms which are defined by bed partner are also observed.
Polysomnography is the gold standard for disease diagnosis. As well as
polysomnography, physical examination, radiological diagnosis, and
endoscopic diagnosis are also used [3].
Prevalence of coronary artery disease in patients with OSAS was found
high. Not only systemic hypertension, but also pulmonary hypertension,
heart failure, arrhythmia, stroke, and myocardial infarction can be
observed. All these situations increase morbidity and mortality related
to OSAS [4-5].
It has been argued that the rate of undiagnosed OSAS
among surgical patients was between 21-28% 3. It is important to
diagnose patients with OSAS in preoperative period in terms of
preventing development of complications which can put patients' life in
danger. A retrospective study of Gupta et al. (2001) reported that 25%
of surgical patients had high risk of OSAS. However, it has been stated
that patients with OSAS cannot be adequately diagnosed by medical staff
in Perioperative period [1].
Because of reasons such as the fact that the
diagnosis process for OSAS is carried out in sleep laboratories, this
process is expensive, and patients do not want to undergo this test,
polysomnography is not carried out routinely. According to American
Society of Anesthesiologists (ASA) diagnosis criteria for OSAS, patients
whose body mass index (BMI) is 35 kg/m2 or over, neck circumference is
42.5 or more cm for males and 41.5 or more cm for females, who have a
history of snoring and sleep apnea, a history of falling asleep easily,
who experience frequency of daytime sleepiness, who are in Grades 3or 4
according to the Mallampati classification are accepted as patients with
high risk of OSAS (Table I).
While taking patients' history, it is necessary for
medical staff, working in surgical departments, to assess the risk of
OSAS using the Mallampati classification scale, information about the
situation of snoring during sleep, apnea, BMI, neck circumference, and
to record on the observation form.
In post-surgery period, the most important
complication observed in patients with OSAS is the development of upper
airway obstruction related to sedation and use of analgesics drugs [6].
For these patients, severe airway complications developed relating to
administering anesthetics, opioid-type analgesics and sedatives increase
mortality and morbidity. These adverse results are mostly associated
with cardiac arrest, difficult intubation, failure in intubation after
administering opioid or sedative drugs, and respiratory tract
obstruction after intubation. Administering sedative premedication on
these patients aggravates airway obstruction thus; some authorities
recommend to avoid premedication which is administered using sedatives [7].
It has been stated that increase in complications
relating to hypertension, cardiac arrhythmia increase, oxygen
desideration, airway obstruction, reintubation, cerebral death, and
death was observed among patients with OSAS in post-surgery period [8].
A study of Laiao et al. stated that there was higher risk of difficult
intubation for patients with OSAS because of their additional diseases,
that the risk of experiencing postoperative complications such as
hypoxaemia increased two times. Because these patients are not diagnosed
in preoperative period, it will be more hard to diagnose complications
when routine monitoring interval extends3. Therefore, determination of
individuals with the risk of OSAS in preoperative period, oxygen
saturation in postoperative period, monitor zing them in terms of
possible respiratory and cardiac complications, if possible, closely
monitoring them in intensive care unit or in service are recommended [9].
If necessary, in-service training programs on diagnosing patients with
OSAS, monitoring them, and providing them necessary care can be
organized for the medical staff working in surgical services.
Conflict of interest
I declare if any economic interest or any conflict of interest exists.
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