The perioperative implications of the patient with Obstructive Sleep Apnea (OSA) - a narrative review.
Level 5 - mechanism / opinion, no new human data
Narrative review without systematic search or primary data synthesis
PubMed 40746078 · doi:10.1080/20565623.2025.2540744
What was done
This narrative review synthesized current guidelines (including American Society of Anesthesiologists and Society of Anesthesia and Sleep Medicine recommendations) and clinical evidence regarding the preoperative screening, intraoperative airway and pharmacological management, and postoperative recovery of surgical patients with known or suspected obstructive sleep apnea (OSA), particularly in ambulatory settings.
What was found
The authors report that approximately 80% of OSA cases remain undiagnosed preoperatively. Patients with an apnea-hypopnea index (AHI) >70 have an estimated ~28% probability of difficult intubation, and OSA elevates the risk of opioid-induced respiratory depression by up to 50%. The review notes that outpatient surgery remains feasible for medically optimized patients adherent to CPAP, with multimodal opioid-sparing analgesia, alternative sedatives (such as dexmedetomidine and ketamine), and postoperative non-invasive respiratory support (CPAP or high-flow nasal cannula) serving to mitigate respiratory complications.
Why it matters
It provides a consolidated summary of perioperative risks and airway management strategies for clinicians treating OSA patients in increasingly common outpatient surgical contexts.
Limits
The paper is a non-systematic narrative review and does not employ a structured literature search, risk-of-bias assessment, or quantitative data synthesis. Specific study counts, sample sizes, and detailed statistical measures for most recommendations are not reported in the abstract.
Cited by
- supports Between 70% and 80% of sleep disorders go undiagnosed.