Archive October 2017 XVIII, No. 10

5 Tips for Safely Handling Sleep Apnea Patients

Most of your obstructive sleep apnea patients don't even know they have it.

Timothy Schmidt

Timothy Schmidt, CRNA


sleep apnea SAFE OUTCOME Sleep apnea, which is often undiagnosed, increases a patient's anesthetic risk.

As a nurse anesthetist who works in a variety of surgical settings, from office-based suites to trauma hospitals, I can expect to encounter at least one patient with obstructive sleep apnea (OSA) almost every day — either diagnosed or undiagnosed. Interestingly, up to 85% of people with OSA are undiagnosed, and research indicates that up to 30% of patients undergoing routine endoscopy either have OSA or are at a high risk for a positive screen. I consider properly handling OSA one of my top priorities. Here's my 5-point plan designed to make sure OSA patients have a safe and uneventful perioperative experience.

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 relaxation, regardless whether the sleep is due to natural causes or pharmacologically 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 leading 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.

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