Institute for Continuing Education

Anesthesia and Sleep Apnea

Course Objectives

Upon successful completion of this module, you will be able to:

• Analyze the pathophysiological mechanisms linking obstructive sleep apnea (OSA) to perioperative complications and explain evidence-based risk stratification strategies for patients with sleep-disordered breathing undergoing anesthesia.
• Compare and contrast the effects of various anesthetic agents (inhalational anesthetics, opioids, sedatives, neuromuscular blocking agents) on upper airway mechanics, respiratory drive, and sleep architecture in patients with and without sleep apnea.
• Evaluate the impact of patient-specific factors including age, obesity, comorbidities, and anatomical considerations on perioperative risk in sleep apnea patients and apply current screening tools (STOP-BANG, ASA guidelines) to identify high-risk individuals.
• Synthesize current evidence-based perioperative management strategies for patients with OSA, including preoperative optimization, intraoperative monitoring considerations, postoperative care protocols, and the role of continuous positive airway pressure (CPAP) therapy in reducing complications.
• Explain the neurophysiological interactions between anesthetic depth, sleep stages, and respiratory control mechanisms, including the differential effects on central versus obstructive apneic events.
• Assess postoperative monitoring requirements and discharge criteria for patients with known or suspected OSA across different surgical settings (ambulatory, inpatient, ICU).

Course Information

Sleep apnea is of particular concern to anesthetists. The patient with disordered breathing during sleep is likely to also have disturbed breathing when sedated. This effect is compounded by sedation-related compromise of arousal, the mechanism that protects the sleeping patient from life threatening consequences of a breathing disturbance. Furthermore, the upper airway abnormalities that predispose to breathing obstruction during sleep may also make tracheal intubation difficult.

This review is presented in three sections. In the first, sleep-related breathing disorders are defined and the pathophysiology, clinical features, and management discussed. In the second, the nature of sleep and anesthesia and their effects on ventilation are considered and in the third, the anesthetic management of patients with sleep apnea examined.