The importance of obstructive sleep apnoea management in peri‐operative medicine

Obstructive sleep apnoea (OSA) is associated with increased adverse peri-operative outcomes [1–8]. Studies of several large populationbased databases, including millions of patients and two meta-analyses, have shown that patients with OSA have an increased risk of postoperative complications [1–7]. Many adverse postoperative events will be resolved by a longer stay in recovery, but some can be profound and result in mortality (dead-in-bed), as well as life-threatening situations requiring admission to a high dependency (HDU) or intensive care unit (ICU) [9]. The anaesthetist’s role is to identify potential risks, where possible to initiate treatment to minimise those risks, and to plan for post-operative care in a safe environment where any residual risks can be dealt with. Anaesthetists who are concerned that patients with OSA are at higher risk often request the patient be monitored in HDU, a limited and expensive resource. If an HDU bed is not available, surgery may be cancelled, causing distress for the patient and wasting funded operating time. Using the HDU bed for the OSA patient may deprive other patients of that resource. So, are we ‘crying wolf’? A review of the medicolegal and closed claims literature would suggest not [10–15]. Morbidity and mortality in adult and paediatric patients with OSA is well-documented and poor postoperative surveillance features in many of these tragic cases. A failure to recognise the potential problems means that anaesthetic and postoperative management is not adjusted to take account of the increased risk from OSA.