Sleep Apnea and Surgery – Considerations BEFORE and AFTER Surgery

Obstructive sleep apnea (OSA) is a condition that affects about 40% of people undergoing any surgical procedure.  It can have negative consequences to have undiagnosed OSA during a surgical procedure and is best discovered before surgery takes place.  Complications which have taken place felt to be due to OSA during or after surgery include:  reduced oxygen saturation, heart arrhythmias, heart failure / attack, stroke, need for urgent re-intubation due to respiratory failure and death.  There is also an increased chance of  post-operative respiratory infection (like pneumonia) in patients with OSA.

Before Surgery

As surgeons, we can attest to the fact that we HATE surprises in the operating room.  “We” include both the anesthesia and surgical teams.  When a patient with undiagnosed sleep apnea is put under the anesthetic, and they become completely obstructed, it can become very exciting for everyone involved in the room.  We try to identify these patients prior to surgery, but the odd one still pops up, and often requires the procedure to be cancelled once we get the patient awake and breathing again.  That being said, it is important to identify those with sleep apnea in these cases.

People have raised the concern that if surgeons knew they had sleep apnea, they may not want to operate on them.  That “head in the sand” mentality is a sure way to get into trouble.  Doctors will not avoid surgery in these cases, but it does require more preparation for the procedure and how to care for you afterwards.  Remember, we have to put you in a chemically induced state of sleep, and in even a normal state of sleep, those with sleep apnea are not breathing and are secreting stress hormones.  That can really be a problem if we are giving you medications to slow your heart or drop your blood pressure.  It is better if everyone in the room knows what to expect.

Things to consider:

a)  if you fulfill three or more criteria from our survey, you should inform your surgeon and consider getting tested for sleep apnea. Three or more positive criteria have been associated with a 20% increased risk of post-surgical complications, including an increased risk of death.

b)  If you have sleep apnea and have a CPAP device (and wear it), you should inform your surgeon that you have it.  You should visit your CPAP dispensary and discuss with them the sort of surgery you might be having.  You should get a compliance download from your device and forward it to your surgeon.

c)  If you have sleep apnea but do not have CPAP (or have it but do not wear it), you should still inform your surgeon.  They will have to make sure they take appropriate precautions with you before, during and after surgery which might include admission to a monitored ward after surgery.

As long as everyone has the right information, you and your surgeon can make arrangements to make sure your risks are minimized.

After Surgery

If you have brought CPAP with you to the hospital, the recovery nurses will apply this for you afterwards.  You are going to be under the weather and very drowsy at first, which is a real risk for those with OSA.  The greatest period of risk after surgery is over the first 24 hours.

Ideally, you should have someone with you at home for the first 24 hours, to make sure you are wearing your device appropriately.  If you wear a PAP mask or an oral splinting device, you need to wear it WHENEVER you are sleeping, napping or resting with your eyes closed (on the couch, in a chair, in bed).

If there are any questions, you should speak to the physician who diagnosed your sleep apnea.  Remember, you should always tell your surgeon if you have obstructive sleep apnea so they may take appropriate precautions for you during and after surgery.