Obstructive Sleep Apnea (OSA) and Surgery: What are the Risks? What is Obstructive Sleep Apnea? Obstructive sleep apnea (OSA) is a common sleep disorder. With OSA, breathing pauses during sleep due to a blocked airway. The pause in breathing is called ‘apnea’ or an ‘apneic spell’. People with OSA often have apneic spells that last more than 10 seconds. They may have as many as 20-60 events every hour. This causes them to lose oxygen. Their brain awakens their body so they can start breathing again. What causes OSA? There are several possible causes of OSA: • Muscles of the throat and tongue relax during sleep • Born with a narrow airway, short lower jaw, or large tongue • Overweight: extra fat around the airway causes it to close off • Enlarged tonsils or adenoids What are the signs of OSA? • Snoring • Apnea or gasping while sleeping (often noticed by sleep partner) • Waking up often during sleep • Daytime sleepiness Who is at risk for OSA? You are at risk for OSA if you: • Are overweight • Have high blood pressure • Are male • Are over 50 years old • Are male with a neck size of 17 inches or more • Are female with a neck size of 16 inches or more Is OSA harmful to my health? There are many health risks that may result from untreated OSA. Some of them include: • High blood pressure • Heart Attack • Stroke • Irregular heart beat (arrhythmia) • Coronary artery disease • Car crashes (from falling asleep while driving) • Increased risk after surgery PATIENT IDENTIFICATION Airway in a person with sleep apnea Airway in a person with sleep apnea Normal airway 1 of 2
Transcript
Obstructive Sleep Apnea (OSA) and Surgery: What are the Risks?
What is Obstructive Sleep Apnea?Obstructive sleep apnea (OSA) is a common sleep disorder. With OSA, breathing pauses during sleep due to a blocked airway. The pause in breathing is called ‘apnea’ or an ‘apneic spell’.
People with OSA often have apneic spells that last more than 10 seconds. They may have as many as 20-60 events every hour. This causes them to lose oxygen. Their brain awakens their body so they can start breathing again.
What causes OSA?There are several possible causes of OSA:
• Muscles of the throat and tongue relax during sleep
• Born with a narrow airway, short lower jaw, or large tongue
• Overweight: extra fat around the airway causes it to close off
• Enlarged tonsils or adenoids
What are the signs of OSA? • Snoring• Apnea or gasping while sleeping (often noticed by
sleep partner)• Waking up often during sleep• Daytime sleepiness
Who is at risk for OSA?You are at risk for OSA if you:
• Are overweight• Have high blood pressure• Are male • Are over 50 years old• Are male with a neck size of 17 inches or more• Are female with a neck size of 16 inches or more
Is OSA harmful to my health?There are many health risks that may result from untreated OSA. Some of them include:
• High blood pressure• Heart Attack• Stroke • Irregular heart beat (arrhythmia)• Coronary artery disease• Car crashes (from falling asleep while driving)• Increased risk after surgery
PATIENT IDENTIFICATION
Airway in a person with sleep apnea Airway in a person with sleep apnea
Normal airway
1 of 2
Are there other treatment options? Other forms of treatment depend on the cause and have varying degrees of success. These include:
• A dental device to keep jaw forward during sleep• Nasal valves to slow the out-breath to increase
pressure in the throat (and perhaps keep it open)• Surgery (used with severe OSA) to correct
problems with face structures (rare and only when other treatments have not helped)
How does having OSA increase my risk after surgery?Anesthesia and pain medications sedate you and relax your airway muscles. The effects of anesthesia can linger for a day or so after surgery. Combine that with pain medications, and you are likely to have more and longer apneic spells. If left unchecked, these can lead to serious health problems and even death.
During surgery and recovery, you are constantly being watched. However, after you go to your hospital room or home (with a Same Day Surgery), you are not being watched all the time. This is the time when you are most at risk following surgery.
How can I decrease my surgery risk if I have OSA?Here is how we help decrease your risk with surgery:
1. Primary care providers (PCP) screen for OSA.2. If you are found to be at risk for OSA, you are
referred to a sleep center to have a sleep study done. Ideally this will be done before your surgery.
3. IfyouarediagnosedwithOSA,youwillbefittedwith a CPAP mask and machine to use whenever you are asleep.
4. You will be asked to bring in your mask and machine for use while you are in the hospital.
5. You will be monitored carefully during your stay. When you are discharged, you will be reminded to use your CPAP machine whenever you are asleep.
How is OSA Diagnosed?There are two screening tools that are used to see if you might have OSA. STOP-BANG checks for signs and risk factors as discussed earlier (overweight, high blood pressure, etc.). The Epworth Sleepiness Scale looks at your level of daytime sleepiness.
If you are found to be at high risk for OSA, your provider will refer you to a sleep center for a sleep study. During a sleep study, various tests are done while you sleep. These tests look at the following:
• Brain waves • Breathing effort• Airflowthroughthenoseandmouth• Oxygen levels• How the above results vary based on body position
and stage of sleep.
What is the treatment for OSA?The goal of treatment for OSA is to keep the airway open so breathing does not stop during sleep. The most common and effective treatment for OSA is Continuous Positive Airway Pressure (CPAP).
With CPAP, air is constantly blown into the airway byapumpandtight-fittingfacemask.Althoughittakes some getting used to, most people adjust to it, especially after getting better sleep.
Is there anything I can do myself to help treat OSA or reduce my risk?Lifestyle changes may help mild OSA:
• Weight loss• Not sleeping on your back • Avoiding alcohol and sedatives
