Perioperative and Critical Care Aspects of Sleep Medicine
What you must know
OSA is a perioperative risk factor for difficult airway, postoperative respiratory depression, and cardiac events. Screen with STOP-BANG; a high score warrants caution, not necessarily cancellation. Key strategies: opioid-sparing analgesia, regional anesthesia when possible, preoperative PAP for known OSA, and postoperative monitoring with continuous pulse oximetry in high-risk patients. Avoid sedative premedication in severe OSA.
In the ICU, sleep is profoundly disrupted by noise, light, and care interruptions. Sleep deprivation impairs weaning and immune function. Delirium risk rises with sleep fragmentation. Noninvasive ventilation and PAP are used for OSA and OHS in critically ill patients; watch for treatment-emergent central apnea and mask-related complications.
Obesity hypoventilation patients are at high risk for post-extubation failure; extubation should follow careful assessment of ventilation.
Traps
- Assuming a normal STOP-BANG excludes OSA.
- Forgetting that opioids and sedatives worsen OSA and central apnea.
- Missing OHS in the ICU patient with chronic hypercapnia.
- Overlooking that sleep in the ICU is not restorative even when total hours seem adequate.
Rule of thumb
"Screen, spare opioids, and monitor." High-risk OSA patients need continuous postoperative oximetry and early PAP resumption.
Worked example
A patient with BMI 42 and known OHS undergoes urgent surgery. Use regional anesthesia if feasible, minimize opioids, resume PAP early postoperatively, and monitor with continuous oximetry and capnography.