Perioperative Adverse Events in Obstructive Sleep Apnea and Use of Noninvasive Mechanical Ventilation: Key Topics and Clinical Implications

Obstructive sleep apnea (OSA) is a common public health care problem and, yet, the perioperative management of OSA remains inadequate. Patients affected by this condition are prone to early postoperative complications, in part due to the negative effects of sedative, analgesic, and anesthetic agents on pharyngeal tone and arousal responses to hypoxia, hypercapnia, and obstruction. The use of opioids may also contribute to late adverse events, mainly by suppressing the rapid eye movement phase of sleep. As a result, preoperative screening of patients at high risk of OSA, as well as the implementation of a perioperative strategy to reduce the risk of complications, should lead to early perioperative interventions capable of improving patient outcome. The objective of this chapter is to give the reader an overview of the treatment of patients with OSA or at high risk for OSA in the surgical setting and to find a possible role for noninvasive ventilation to prevent critical respiratory events.