The ASAA strongly encourages anesthesiologists and pain physicians to screen their patients for sleep apnea before the patients undergo sedation or any type of anesthesia and before they are given pain medications that can affect their respiratory drive or relax their muscles. Most patients with sleep apnea do not know that they have the disorder, and anesthesiologists and pain physicians can play a key role in helping us to reach the undiagnosed. For more about sleep apnea in pain patients, read "Pain and Sleep Apnea."
Two key questions to ask patients on the pre-surgery and pain questionnaire are:
- Do you snore?
yes no don't know
- Do you ever fall asleep easily and/or sometimes inappropriately?
yes no
Two other good questions to include are:
- Do you feel tired or groggy on awakening?
yes no don't know
- Do you have morning headaches?
yes no
The anesthesiologist should also consider the risk factors (see below) and presenting symptoms of sleep apnea. When in doubt as to the presence of sleep apnea, treat the patient as if it is present (and consider whether it is appropriate to delay surgery until the sleep apnea has been diagnosed and treated). For more information, read the ASAA position statement "Sleep Apnea and Same-Day Surgery" and the articles at the end of the statement. "OSA Can Complicate Anesthesia Delivery" can also be helpful. The American Academy of Sleep Medicine has also published a paper on the subject entitled "Upper Airway Management of the Adult Patient with Obstructive Sleep Apnea in the Perioperative Period: Avoiding Complications."
In addition, the American Society of Anesthesiologists has posted on its website information about sleep apnea and anesthesia for patients: Wake up to the Effects of Sleep Apnea.
The ASAA also encourages anesthesiologists to provide appropriate post-op monitoring. CPAP should be used in the recovery room and on the floor. For more information on monitoring, read "Sleep Apnea and Same-Day Surgery" and the articles at the end of the statement, especially "Sleep Apnea and Narcotic Postoperative Pain Medication: A Morbidity and Mortality Risk", as well as "OSA Can Complicate Anesthesia Delivery".
Memorial Hospital in Colorado Springs has implemented several programs to screen patients before anesthesia is given and to monitor patients post-operatively. Information about sleep apnea is on the hospital's website where patients already on CPAP are told to bring their machine for the surgery. Screening questions about sleep apnea and snoring are on the pre-surgery questionnaire for both adults and children. Patients whom Memorial personnel suspect have sleep apnea receive a letter recommending further assessment for sleep apnea; their primary care physician also receives notice of Memorial's findings and recommendation. The monitoring protocol is followed for all suspected and diagnosed sleep apnea patients.
Defining Apnea: "without breath"
An apnea is clinically defined in adults as a cessation of breath that lasts at least ten seconds and in children as a cessation of breath that lasts the equivalent of two-and-a-half missed breaths. People with untreated sleep apnea stop breathing repeatedly during sleep, as frequently as hundreds of times during the night and sometimes for a minute or longer. Blood oxygen levels typically drop with each apnea and hypopnea.
Prevalence
It is conservatively estimated that at least 12 million Americans suffer from sleep apnea, most of whom are undiagnosed. In considering which of your patients have sleep apnea, you may want to read "Sleep Apnea and BMI: The Majority of OSA Patients Are Not Obese".
Types of Apnea
- Central (where the airway is not blocked and with no neurological signal to breathe, there is no respiratory effort)
- Obstructive (the most common)
- Mixed (a combination of the above which begins as central and becomes obstructive and is treated as obstructive)
Risk Factors for Sleep Apnea
- A family history of sleep apnea
- Excess weight
- A large neck
- A recessed chin
- Male sex
- Abnormalities in the structure of the upper airway
- Smoking
- Alcohol use
- Age
Yet sleep apnea can affect both males and females of all ages (including children) and any weight.
Presenting Symptoms
- Loud snoring
- Excessive daytime sleepiness (i.e., falling asleep easily and sometimes inappropriately)
- High blood pressure and other cardiovascular complications
- Morning headaches
- Memory problems
- Feelings of depression
- Reflux
- Nocturia
- Impotence
Treatments for Sleep Apnea
- Avoidance of alcohol and medications that relax the airway and/or reduce respiratory drive
- Weight loss
- Positional therapy, i.e., avoiding sleeping on the back (for adults)
- Oral appliances
- Surgery (a tonsillectomy and adenoidectomy is the most common treatment for pediatric patients)
- Continuous positive airway pressure (CPAP)
The most appropriate treatment depends on an individual’s medical history and the severity of the disorder.
View the article from Sleep Review on sleep apnea and anesthesia.
The ASAA can help you easily and efficiently help your patients understand sleep apnea.
The ASAA offers numerous patient educational publications, as well as brochures to explain sleep apnea, a video, and newsletter reprints on specific topics. (You can also use the brochures to help reach the undiagnosed in your community.) For more information about communicating effectively with patients, visit the website of the Partnership for Clear Health Communication and learn more about its Ask Me 3 program.
If you are interested in increasing CPAP compliance, read "If Your Patient Is Not Complying with CPAP".
View our position statements and testimonies.
Professsionals can also become members and support the ASAA.
 | The American Sleep Apnea Association is
proud to be a member of the American Chronic Pain Association's Partnership
for Understanding Pain. For more information, visit the ACPA website:
www.theacpa.org. |
