Obstructive Sleep Apnea and the Adult Perioperative Patient

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Presentation transcript:

Obstructive Sleep Apnea and the Adult Perioperative Patient Dennis L. Spence, NC, USN, PhD, CRNA, Tony Han, MC, USN, Jason McGuire, NC, USN, PhD, CRNA, Darren Couture, NC, USN, PhD, CRNA Journal of PeriAnesthesia Nursing Volume 30, Issue 6, Pages 528-545 (December 2015) DOI: 10.1016/j.jopan.2014.07.014 Copyright © 2015 Terms and Conditions

Figure 1 Proposed conceptual framework for anesthesia and obstructive sleep apnea. (−) decreased; (+) increased; (++) moderately increased; and (+++) significantly increased. Framework based on understanding of the pathophysiology of OSA and known effects of anesthetic agents, surgery, and opioids on OSA.4,7,15-21 OSA, Obstructive sleep apnea; PACU, postanesthesia care unit; ICU, intensive care unit; REM, rapid eye movement sleep; AHI, apnea/hypopnea index; LSAT, lowest oxygen saturation; T90 & T85, time with SPO2 less than 90% & 85%; STOP-BANG, Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index greater than 35 kg/m2, Age older than 50, Neck circumference greater than 40 cm, and male Gender; POD, postoperative day. This figure is available in color online at www.jopan.org. Journal of PeriAnesthesia Nursing 2015 30, 528-545DOI: (10.1016/j.jopan.2014.07.014) Copyright © 2015 Terms and Conditions

Figure 2 Comparison of normal and OSA subject airway. Volumetric reconstructions from a series of 3-mm contiguous axial magnetic resonance images of the mandible (gray), tongue (orange/rust), soft palate (purple), lateral parapharyngeal fat pads (yellow), and lateral/posterior pharyngeal walls (green) in a weight-matched normal subject (top) and patient with sleep apnea (bottom), both with an elevated BMI (32.5 kg/m2). Note that the airway is larger in the normal subject than in the apneic subject. The tongue, soft palate, and lateral pharyngeal walls are larger in the patient with sleep apnea.22 BMI, body mass index. Reprinted with permission of the American Thoracic Society. © 2014 American Thoracic Society. This figure is available in color online at www.jopan.org. Journal of PeriAnesthesia Nursing 2015 30, 528-545DOI: (10.1016/j.jopan.2014.07.014) Copyright © 2015 Terms and Conditions

Figure 3 Effects of remifentanil infusion on oxygen saturations in patients with msoderate OSA. Remifentanil is an ultra-short-acting opioid infusion. Compared with moderate OSA patients' baseline polysomnography, the severity and duration were significantly greater during the remifentanil infusion. SaO2, oxygen saturation. Figure created from data published by Bernards et al15 (Reprinted with permission from Anesthesia Abstracts.). This figure is available in color online at www.jopan.org. Journal of PeriAnesthesia Nursing 2015 30, 528-545DOI: (10.1016/j.jopan.2014.07.014) Copyright © 2015 Terms and Conditions

Figure 4 Percent REM sleep and ODI 4%. Results are given as median (interquartile range). ODI 4% is the number of oxygen desaturation events of greater than or equal to 4%. There was a significant decrease in percent REM sleep between preoperative night 1 and postoperative night 1 (P = .02) and significantly higher percent REM sleep on postoperative night 5 when compared with postoperative night 1 (P = .01). REM, rapid eye movement; ODI, oxygen desaturation index. Figure created from results published by Dette et al21 (Reprinted with permission from Anesthesia Abstracts). This figure is available in color online at www.jopan.org. Journal of PeriAnesthesia Nursing 2015 30, 528-545DOI: (10.1016/j.jopan.2014.07.014) Copyright © 2015 Terms and Conditions