POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME UNDERGOING GENERAL ANESTHESIA
DOI:
https://doi.org/10.71000/p7751643Keywords:
Continuous Positive Airway Pressure (CPAP),, Respiratory Depression, Anesthesia, Cardiovascular Complications, Obstructive Sleep Apnea, Postoperative Pain, STOP-BANG QuestionnaireAbstract
Background: Obstructive sleep apnea (OSA) is a common but frequently undiagnosed sleep-related breathing disorder that increases perioperative risk due to recurrent upper airway obstruction, oxygen desaturation, and autonomic instability. Even in mild or unrecognized cases, OSA can significantly raise the likelihood of respiratory and cardiovascular complications following surgery. In light of evolving anesthesia techniques and perioperative care, understanding OSA's true clinical burden is essential for enhancing patient safety and recovery.
Objective: To determine the incidence and types of postoperative complications—particularly respiratory and cardiovascular—in patients with OSA undergoing general anesthesia, and to explore strategies that reduce perioperative morbidity and improve surgical outcomes.
Methods: This cross-sectional study was conducted over four months in the surgical departments of two tertiary hospitals in Lahore. A total of 80 adult patients (45 males, 35 females) diagnosed or suspected with OSA and undergoing general anesthesia for elective procedures were enrolled. Data collection involved preoperative screening using the STOP-BANG questionnaire, intraoperative anesthesia records, and postoperative complication tracking in the Post-Anesthesia Care Unit (PACU). Vital signs and the duration of anesthesia were also recorded. Statistical analysis was performed using SPSS version 26.
Results: Respiratory complications were observed in 30% of patients, including oxygen desaturation (15%), respiratory failure (10%), and respiratory arrest (5%). Cardiovascular events occurred in 20%, with hypertension and hypotension each affecting 10% and 5% respectively, along with arrhythmias (5%). Moderate to severe postoperative pain was reported in 80%, and postoperative nausea and vomiting (PONV) affected 40%. The mean hospital stay was 3.2 days. STOP-BANG scores ≥5 correlated with increased complication rates and prolonged anesthetic duration.
Conclusion: Patients with OSA undergoing general anesthesia face elevated risks of cardiorespiratory complications and postoperative morbidity. Structured preoperative screening, optimized airway strategies, and adherence to CPAP protocols are essential to improve patient safety and surgical outcomes.
References
Seet E, Nagappa M, Wong DT. Airway Management in Surgical Patients With Obstructive Sleep Apnea. Anesth Analg. 2021;132(5):1321-7.
Chen L, Liu D, Zhong J, Qiu S, Zhou Y. [Analyzing the reasons for and prevention of serious complications after general anesthesia in children with obstructive sleep apnea]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2025;39(2):168-72.
Pappu A, Singh M. Best perioperative practices in the management of obstructive sleep apnea patients undergoing ambulatory surgery. Curr Opin Anaesthesiol. 2024;37(6):644-50.
Filipek N, Kirkham E, Chen M, Ma CC, Horn DL, Johnson KE, et al. Drug-induced sleep endoscopy directed surgery improves polysomnography measures in overweight and obese children with obstructive sleep apnea. Acta Otolaryngol. 2021;141(4):397-402.
Berezin L, Nagappa M, Wong J, Clivatti J, Singh M, Auckley D, et al. Identification of Sleep Medicine and Anesthesia Core Topics for Anesthesia Residency: A Modified Delphi Technique Survey. Anesth Analg. 2021;132(5):1223-30.
Albrecht E, Bayon V, Hirotsu C, Heinzer R. Impact of short-acting vs. standard anaesthetic agents on obstructive sleep apnoea: a randomised, controlled, triple-blind trial. Anaesthesia. 2021;76(1):45-53.
Albrecht E, Wegrzyn J, Rossel JB, Bayon V, Heinzer R. Impact of spinal versus general anaesthesia on perioperative obstructive sleep apnoea severity in patients undergoing hip arthroplasty: a post hoc analysis of two randomised controlled trials. Br J Anaesth. 2024;133(2):416-23.
Albrecht E, Bayon V, Hirotsu C, Al Ja'bari A, Heinzer R. Intrathecal morphine and sleep apnoea severity in patients undergoing hip arthroplasty: a randomised, controlled, triple-blinded trial. Br J Anaesth. 2020;125(5):811-7.
Elghamry MR, Anwar AG, Zahra SW. Opioid-sparing effect of erector spinae plane block and intravenous dexmedetomidine for obese patients with obstructive sleep apnea: A randomized controlled trial. J Opioid Manag. 2024;20(3):243-53.
Ceban F, Yan E, Pivetta B, Saripella A, Englesakis M, Gan TJ, et al. Perioperative adverse events in adult patients with obstructive sleep apnea undergoing ambulatory surgery: An updated systematic review and meta-analysis. J Clin Anesth. 2024;96:111464.
Weingarten TN, Sprung J. Perioperative considerations for adult patients with obstructive sleep apnea. Curr Opin Anaesthesiol. 2022;35(3):392-400.
Cozowicz C, Memtsoudis SG. Perioperative Management of the Patient With Obstructive Sleep Apnea: A Narrative Review. Anesth Analg. 2021;132(5):1231-43.
Golaz R, Tangel VE, Lui B, Albrecht E, Pryor KO, White RS. Post-operative outcomes and anesthesia type in total hip arthroplasty in patients with obstructive sleep apnea: A retrospective analysis of the State Inpatient Databases. J Clin Anesth. 2021;69:110159.
Bolden N, Posner KL, Domino KB, Auckley D, Benumof JL, Herway ST, et al. Postoperative Critical Events Associated With Obstructive Sleep Apnea: Results From the Society of Anesthesia and Sleep Medicine Obstructive Sleep Apnea Registry. Anesth Analg. 2020;131(4):1032-41.
Habchi KM, Tangel VE, Weinberg RY, White RS, Kelleher DC. Postoperative outcomes and anesthesia type in total knee arthroplasty in patients with obstructive sleep apnea. J Comp Eff Res. 2022;11(17):1241-51.
Barman RA, Fields AR, Eells AJ, Kouri I, Mansukhani MP, Gali B, et al. Postoperative outcomes in patients with treatment-emergent central sleep apnea: a case series. J Anesth. 2020;34(6):841-8.
Stewart M, Estephan L, Thaler A, Zhan T, Connors K, Malkani K, et al. Reduced Recovery Times with Total Intravenous Anesthesia in Patients with Obstructive Sleep Apnea. Laryngoscope. 2021;131(4):925-31.
Roy B, Kumar R, Sarovich SD, Vacas S. The Role of the Glymphatic System in Perioperative Neurocognitive Disorders. J Neurosurg Anesthesiol. 2025;37(2):181-7.
Seguin L, Mendelson M, Doutreleau S, Clin R, Destors M, Albaladejo P, et al. Temporal link between cardiac arrhythmias and postoperative episodes of hypoxemia during nocturnal sleep in patients with obstructive sleep apnea syndrome. Sleep Med. 2024;124:260-7.
Altree TJ, Chung F, Chan MTV, Eckert DJ. Vulnerability to Postoperative Complications in Obstructive Sleep Apnea: Importance of Phenotypes. Anesth Analg. 2021;132(5):1328-37.
D.J. Gottlieb et al. Diagnosis and management of obstructive sleep apnea: a review JAMA (2020).
K.T. Ng et al. Association of obstructive sleep apnea and postoperative cardiac complications: a systematic review and meta-analysis with trial sequential analysis J Clin Anesth (2020).
S. Zeineddine et al. Oxygen therapy in sleep disordered breathing Chest (2021)
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Copyright (c) 2025 Sadia Saleem, Faryal Falak , Huma Ejaz, Muskan Amjad, Muhammad Faizan, Saman Riaz (Author)
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