Review of surgery for obstructive sleep apnea

Archives of Otolaryngology - Head & Neck Surgery, released an article today, looking at the ramifications of Surgery for Obstructive Sleep Apnea, which is when a person experiences pauses in breathing while they are asleep. When a patient undergoes a surgical procedure to correct the obstruction in their airway, traditional thought categorizes them as in a dangerous and potentially life threatening post operative state. They need to be monitored with caution, because these patients are at higher risk for airway compromise. Kenny P. Pang, F.R.C.S.Ed., F.R.C.S.I.(OTO), of the Pacific Sleep Centre, Singapore, and colleagues reviewed data from nearly 500 patients with obstructive sleep apnea (OSA) who underwent surgical procedures from January 2007 to May 2010. The surgeries to correct sleep apnea included nasal, palate and tongue procedures. The total complication rate was 7.1 percent. The 487 patients had undergone a total of 1,698 procedures involving the nasal passages, palate, and tongue. Most of them were adult males, and their average age was 43. Their average apnea-hypopnea index was 47.3, and the mean lowest oxygen saturation level was 75.4%. Patients who had surgery only on the palate or nasal area, were generally monitored for six or more hours and then released. Where surgery also involved the tongue, they were moved to a high dependency area after the operation, and kept overnight for observation. Only one patient had severe problems after the operation, caused by a hematoma extending to the base of the tongue and needed nasoendotracheal intubation. He recovered after three days. Other complications included oxygen desaturation, hypertension, and edema. While the problems can be exacerbated by the depressive nature of anesthetics, which consist of anesthetic agents like muscle relaxants and narcotics, they suggest that patients may not need to be kept in intensive care; only that they be monitored in a high-dependency area of the hospital ward for at least three hours after surgery. The authors conclude: "Patients with OSA typically have small retrognathic mandibles (lower jaw) with difficult airways and, hence, present as difficult intubations to the anesthesiologists ... In addition, respiratory depression from c are well documented in these patients ... In conclusion, we strongly recommended that the clinician manage the patient with OSA with caution and prudence, with the understanding that these patients have a higher risk of airway compromise and respiratory depression intraoperatively and postoperatively." Sleep Apnea is certainly something to be taken seriously, with new research showing that the poor breathing at night is associated with several heart conditions that often correct themselves with treatment.