From the Research
Patients with moderate obstructive sleep apnea (OSA) can generally be cleared for hernia surgery with appropriate perioperative management, as recommended by the most recent and highest quality study 1.
Key Considerations
- Preoperative evaluation should include optimization of CPAP compliance and assessment of any cardiovascular comorbidities, as OSA patients are at increased risk of perioperative complications 2.
- During surgery, the anesthesia team should be informed about the OSA diagnosis to guide airway management decisions, as OSA patients are at higher risk of difficult airway management 1.
- Postoperatively, judicious use of opioids is recommended, with preference for multimodal analgesia including acetaminophen, NSAIDs, and regional anesthesia techniques when possible, to minimize the risk of respiratory depression 1.
Perioperative Management
- Patients should continue using their CPAP therapy before and after surgery, bringing their device to the hospital for postoperative use, as CPAP has been shown to reduce respiratory and cardiovascular complications in OSA patients 2.
- Close monitoring for respiratory depression is essential in the immediate postoperative period, particularly during the first 24-72 hours, as OSA patients are at increased risk of postoperative respiratory complications 1.
- Patients should be positioned in non-supine positions when possible and encouraged to use their CPAP during sleep and naps, to minimize respiratory complications 1.
Additional Considerations
- Early ambulation and resumption of CPAP therapy can help minimize respiratory complications, and should be encouraged in the postoperative period 1.
- The use of oral appliances may be considered as an alternative to CPAP in some patients, but CPAP remains the first-line treatment for moderate to severe OSA 3, 4.
- Combination therapy with CPAP and oral appliance may be beneficial for patients with incomplete responses to oral appliance therapy alone, or those who cannot tolerate high CPAP levels 5.