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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Minerva Anestesiologica 2017 Apr 11

DOI: 10.23736/S0375-9393.17.11688-3


lingua: Inglese

Perioperative management of obstructive sleep apnea: a systematic review

Ruggero CORSO 1, Vincenzo RUSSOTTO 2, Cesare GREGORETTI 2, Davide CATTANO 3

1 Anesthesia and Intensive Care Section, Emergency Department, “GB Morgagni-L. Pierantoni” Hospital, Forli, Forlì-Cesena, Italy; 2 Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, University Hospital Paolo Giaccone, University of Palermo, Palermo, Italy; 3 UTHealth, McGovern Medical School Houston, Houston, TX, USA


Obstructive sleep apnea (OSA) is the leading sleep disordered breathing condition, with a prevalence rate of moderate to severe OSA of approximately 10 – 17% in the general population. Its prevalence in the surgical population seems to be higher. However, a proportion of up to 60% of patients may not have a formal diagnosis at the moment of preoperative visit. OSA is associated with a number of comorbidities and increased perioperative risks. However, most interventions for the perioperative management of OSA patients lack high quality evidence. Although in-laboratory polysomnography represents the gold-standard for diagnosis of OSA, it is costly and time-consuming. Anesthesiologists may screen patients for OSA through one of the available questionnaires, of which the snoring, tiredness, observed apnea, high blood pressure (STOP) – body mass index, age, neck circumference and gender (Bang), STOP-bang questionnaire is the most studied and externally validated. Although its sensitivity for the identification of mild OSA patients is 83.6%, its specificity is only 56.4%, leading to possible false positive results. OSA patients are associated with a higher risk of both difficult ventilation and intubation. However, practice guidelines do not recommend a specific airway management approach and refer to available guidelines for difficult airway management. Perioperative CPAP use may be of benefit since it has been reported to be associated with a reduction of both respiratory and cardiovascular complications and symptom relief. When feasible, regional anesthesia techniques and a multimodal analgesia approach should be adopted to reduce intraoperative and postoperative exposure to opioids.

KEY WORDS: Obstructive sleep apnea - Sleep apnea syndrome - Sleep disordered breathing - Preoperative management - Polysomnography

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Per citare questo articolo

Corso R, Russotto V, Gregoretti C, Cattano D. Perioperative management of obstructive sleep apnea: a systematic review. Minerva Anestesiol 2017 Apr 11. DOI: 10.23736/S0375-9393.17.11688-3 

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