Obstructive sleep apnea (OSA) has been recognized to increase the risk of adverse cardiopulmonary perioperative outcomes for some time now.1 An ever growing body of literature supports this finding,2 including a large prospective study published in 2019 highlighting the significant risk of poor cardiac-related postoperative outcomes in patients with unrecognized OSA.3 As the majority of patients presenting for elective surgery with OSA will not be diagnosed at the time of presentation,3,4 many centers have developed preoperative screening programs to identify these patients, though the practice is not universal and a desire for better guidance is needed.5 In addition, best practices for patients with suspected or known OSA undergoing surgery have been a matter of debate. Out of these concerns, the Society of Anesthesia and Sleep Medicine (SASM) was formed over 10 years ago to promote interdisciplinary communication, education, and research into matters common to anesthesia and sleep.
Pulmonary and sleep medicine providers are often asked to provide preoperative clearance and recommendations for patients with suspected or known OSA. Recognizing the need for guidance in this area, a task force assembled by SASM obtained input from experts in anesthesiology, sleep medicine, and perioperative medicine to develop and publish an evidence-based / expert consensus guideline on the preoperative assessment and best practices for patients with suspected or known OSA.6 While specifics regarding logistics of preoperative screening and optimization of patients will vary based on each medical center’s infrastructure and organization, the recommendations presented should be able to be adapted by most, if not all, institutions. Preoperative evaluation and management is only part of the overall perioperative journey however, and SASM thus followed this document with guidelines for the intraoperative management of patients with OSA.7 To complete this set of recommendations, guidelines for the postoperative care of these patients are being planned. Guidelines for pediatric and obstetric perioperative OSA management are also currently being developed by SASM task forces to address these unique areas.
OSA is not the only sleep disorder where the perioperative environment may pose problems for our patients. Sleep disorders such as the hypersomnias and sleep-related movement disorders (including restless legs syndrome) may both impact and be impacted by the perioperative environment and may create safety concerns for some patients.8,9 These issues are also under active investigation by SASM. In addition, understanding the basic mechanisms determining unconsciousness in both anesthesia and sleep, as well as examination of the interrelationships between sleep disturbance, sedation and their effects on clinical outcomes, are areas of interest that have implications beyond the perioperative arena.
SASM is currently planning to host its 10th anniversary conference in Washington DC on October 1-2, public health issues permitting. The meeting has consistently enlisted expert speakers from anesthesia, sleep medicine, and other relevant fields, and this year will be no different. Given the host city, discussions on important healthcare policy issues will be included, as well. Registration for the meeting, as well as meeting updates, are on the SASM website (sasmhq.org).
Dr. Auckley is with the Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Professor of Medicine, Case Western Reserve University, Cleveland, OH. He is the current president of the Society of Anesthesia and Sleep Medicine.
References
1. Gupta RM, et al. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: A case-control study. Mayo Clin Proc. 2001;76(9):897.
2. Opperer M, et al. Does obstructive sleep apnea influence perioperative outcome? A qualitative systematic review for the Society of Anesthesia and Sleep Medicine Task Force on Preoperative Preparation of Patients with Sleep-Disordered Breathing. Anesth Analg. 2016;122(5):1321.
3. Chan MTV, et al. Association of unrecognized obstructive sleep apnea with postoperative cardiovascular events in patients undergoing major noncardiac surgery. JAMA. 2019;321(18):1788.
4. Finkel KJ, et al. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic center. Sleep Med. 2009;10(7):753.
5. Auckley D, et al. Attitudes regarding perioperative care of patients with OSA: a survey study of four specialties in the United States. Sleep Breath. 2015;19(1):315.
6. Chung F, et al. Society of Anesthesia and Sleep Medicine Guidelines (SASM) on Preoperative Screening and Assessment of Adult Patients with Obstructive Sleep Apnea. Anesth Analg. 2016;123(2):452.
7. Memtsoudis SG, et al. Society of Anesthesia and Sleep Medicine Guideline (SASM) on Intraoperative Management of Adult Patients with Obstructive Sleep Apnea. Anesth Analg. 2018;127(4):967.
8. Hershner S, et al. Knowledge gaps in the perioperative management of adults with narcolepsy: A call for further research. Anesth Analg. 2019 Jul;129(1):204.
9. Goldstein C. Management of restless legs syndrome / Willis-Ekbom disease in hospitalized and perioperative patients. Sleep Med Clin. 2015;10(3):303.