Upper airway management of the adult patient with obstructive sleep apnea in the perioperative period--avoiding complications

PURPOSE

To help practitioners avoid adverse perioperative events in patients with obstructive sleep-disordered breathing.

REVIEWERS

Members of the American Academy of Sleep Medicine's Clinical Practice Review Committee.

METHODS

A search of MEDLINE database using MeSH terms apnea, obstructive sleep apnea and anesthesia was conducted in October 2001. This review focuses on articles published in English between 1985 and 2001 that pertain to non-upper airway surgery in obstructive sleep apnea patients.

RESULTS AND CONCLUSIONS

Scientific literature regarding the perioperative risk and best management techniques for OSAHS patients is scanty and of limited quality. There is insufficient information to develop an AASM standards of practice recommendation. Therefore, the Clinical Practice Review Committee (CPRC) used the available data to make this statement based upon a consensus of clinical experience and published peer-reviewed medical evidence. Important components of the perioperative management of OSAHS patients include a high degree of clinical suspicion, control of the airway throughout the perioperative period, judicious use of medications, and appropriate monitoring. Further research is needed to define the magnitude of risk and optimal perioperative care.

Nonprescription treatments of snoring or obstructive sleep apnea: an evaluation of products with limited scientific evidence

PURPOSE

To evaluate the level of evidence regarding the safety and efficacy of nonprescription therapies used to treat snoring and obstructive sleep apnea, and form a consensus statement based on available data.

REVIEWERS

Members of the American Academy of Sleep Medicine's Clinical Practice Review Committee.

METHODS

A search of PubMed database using MeSH terms snore, apnea, and obstructive sleep apnea in August, 2002, including only articles published in English between 1990 and 2002 and of the World Wide Web, using Google search engine and the key words snoring and obstructive sleep apnea. Letters were sent to manufacturers of lubricant oral and nasal products requesting copies of scientific studies to support their claims.

RESULTS AND CONCLUSIONS

Given the paucity and quality of scientific literature regarding the nonpharmacologic treatment of snoring and obstructive sleep apnea, members of the Clinical Practice Review Committee had insufficient information to develop standards of practice recommendations. Nevertheless, substantial publicity regarding such treatments is available to the general public. Very limited data are available to support a beneficial effect of these devices on snoring and minimal evidence is available to support their use in treating obstructive sleep apnea. Studies are limited by small numbers of participants and, in some instances, inadequate design, lack of statistical analysis, and sparse use of objective measurements. Many studies do not evaluate product safety, especially over extended use. Physicians may find this information useful in counseling their patients.