A patient with obstructive sleep apnea (OSA) may have a number of perioperative complications. Since many patients with obstructive sleep apnea may be undiagnosed all patients undergoing anesthesia should be screened for signs or symptoms of the disorder.

Historical findings:

(1) history of obstructive sleep apnea

(2) history of difficult intubation

(3) history of snoring

(4) observations by family members of apneic episodes while sleeping

(5) sudden awakenings with a sense of choking

(6) excessive daytime sleepiness

(7) history of a neuromuscular disorder (poliomyelitis, amyotrophic lateral sclerosis, muscular dystrophy)

(8) accidents because of sleepiness during the day


Findings on physical examination:

(1) middle-aged or elderly

(2) obesity

(3) increased neck circumference (shirt size, etc.)

(4) tonsillar hypertrophy

(5) nasal obstruction

(6) large tongue

(7) retrognathia

(8) craniofacial abnormalities

(9) acromegaly

(10) difficulties while attempting intubation


A previously undiagnosed patient with one or more of these findings should be evaluated further, depending on the interval prior to surgery. Evaluation may include sleep studies such as polysomnography.

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