Is Overnight Monitoring Required for Adult Patients Undergoing Surgery for Obstructive Sleep Apnea?

Background

Multilevel surgery for obstructive sleep apnea (OSA) carries a theoretical risk of postoperative respiratory complications. In the recent past, OSA surgery was carried out with planned postoperative intensive care monitoring; however, there is a contemporary trend toward less acute postoperative care environments, or even to outpatient surgery, for many of these patients. This trend, however, was confounded by the 2006 OSA perioperative management guidelines published by the American Society of Anesthesiology suggesting that the incidence of respiratory complications after OSA surgery was relatively high (>10 percent), and that all patients undergoing surgery for OSA should have continuous overnight oxygen saturation monitoring after surgery. It remains controversial what level of monitoring after OSA surgery is the most appropriate, both in terms of patient management and sound resource allocation.

Best Practice

The rate of adverse respiratory events after surgery for OSA is low, and the literature does not support the contention that all patients undergoing OSA surgery require overnight oximetry monitoring. Certain patient groups (such as those with higher preoperative apneic indices and/or cardiovascular comorbidities, and those undergoing tongue base surgery) may be at higher risk for respiratory complications, and should be considered for overnight oximetry monitoring. Most respiratory complications seem to occur within four hours after surgery; therefore, after being monitored for several hours after OSA surgery without respiratory events, and meeting other discharge criteria as appropriate, lower risk patients are suggested as being safe for same-day discharge home at the surgeon’s discretion. Higher-level evidence (1 and 2) would be preferred to support a recommendation to change current practice. However, although it is difficult to obtain such evidence because of randomization concerns, the available evidence, although not randomized, is strongly consistent. Multicenter cohort or randomized trials are needed to better define risk factors for respiratory adverse events after OSA surgery. Read the full article in The Laryngoscope.