Sleep in Otolaryngology Practice: Anatomy, Perioperative Care, and Practice Management
Upper airway anatomy
Key sites of collapse include the nasal valve, palate/retropalatal region, tongue base, and epiglottis. The Muller maneuver and drug-induced sleep endoscopy assess collapse patterns. Craniofacial features (retrognathia, micrognathia, high arched palate) predict risk. Nasal obstruction contributes to OSA and can affect PAP tolerance.
Perioperative considerations
Patients with OSA are at increased risk of perioperative complications, including difficult airway, opioid sensitivity, and postoperative respiratory events. Screen with tools such as STOP-BANG. Optimize PAP before and after surgery, minimize opioids, use multimodal analgesia, and monitor postoperatively. Same-day surgery requires careful selection.
Practice management
Documentation, adherence data, and appropriate coding matter. Coordinated care with sleep medicine improves outcomes. Informed consent should address residual disease and the need for retesting.
Traps
- STOP-BANG is a screening tool, not a diagnosis.
- Postoperative opioid use can precipitate respiratory events in OSA.
- Nasal surgery alone rarely cures OSA; it may improve PAP tolerance.
- Do not assume a negative screen excludes OSA in high-risk anatomy.
Rule of thumb
In a surgical patient with snoring, witnessed apneas, and hypertension, screen with STOP-BANG, optimize PAP, and plan postoperative monitoring.