CPOC: Perioperative Management of Obstructive Sleep Apnoea in Adults

Question 1

CFx of OSA

Answer 1

• Snoring
• Tiredness
• Choking during sleep
• Observed Apnoeas
• Cognitive dysfunction
• Waking headache
• Nocturia
• Insomnia

Question 2

Management of OSA

Answer 2

• Smoking cessation
• Alcohol reduction
• Weight loss and exercise
• Mandibular advancement device
• CPAP- if affecting QOL or moderate and above

Question 3

Perioperative considerations for patients with OSA

Answer 3

• 8x increased risk of airway difficulties
• Regional anaesthesia is considered gold standard where possible
• Caution with interscalene blocks and phrenic nerve palsy
• If using sedation must use capnograph and consider HFNO or CPAP
• Limited opioid strategy
• Full reversal and awake extubation
• Recover and post-op in an area where CPAP can be used
• Only step down to unmonitored area when there is no risk of respiratory depression

Question 4

OSA screening in preoperative obese patients and risk stratification

Answer 4

Low Risk
STOP BANG 1-2
ASA 1-2

Moderate Risk
STOP BANG 3-5
And no other high risk features

High Risk
STOP BANG 6-8
MP >2
Neck circumference >50cm
HCO3 >28
SpO2 on RA <94%
NYHA >2