1. Know your patient
The syndrome of OSA is characterized by repetitive episodes of upper
airway obstruction during sleep. The word "apnea" is a Greek word
that literally means "without breath" and it is clinically defined as a
cessation of breath that lasts at least 10 seconds despite continuing
ventilatory effort. The adult human is one of the only animals to be at
risk for OSA, because our upper airway is a long, soft-walled tube
with no bony support. Instead of bones, we rely on the actions of
muscles to keep the airway open. However, when we sleep we lose
muscle tone, and the deeper the sleep the greater the muscle relax-
ation, regardless whether the sleep is due to natural causes or phar-
macologically induced. In general, the normal, healthy person doesn't
have a problem with OSA, but there are a number of things that can
put a person at greater risk. Obesity (BMI greater than 30) is the lead-
ing cause of OSA in the United States (70-90% of patients with OSA
are obese). Other causes include a large tongue, a small and receding
mandible, enlarged tonsils, nasal obstruction, and a thick or fat neck.
2. Know the risks of OSA associated with surgery
Is your staff aware of the potential complications that can occur due
to improper management of patients with OSA? Catastrophic respira-
tory outcomes of patients with OSA during the perioperative period
have been increasing and are a very serious issue. This is most likely
explained by the increase in obesity among the U.S. general popula-
tion. Brain damage and death in an OSA patient are due to failure to
secure the airway during the induction of anesthesia, respiratory
obstruction shortly after extubation, and respiratory arrest after the
administration of opioids and/or sedation to extubated patients in the
recovery area.
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