A recently published article found Harvard researchers attempting to determine the amount of risk sleep apnea patients faced in surgery as well as trying to propose an optimal surgical procedure to minimize those risks.
How Serious Are the Risks?
Provocatively entitled, “Perioperative Sleep Apnea: A Real Problem or Did We Invent a New Disease?” the review looks in detail at research about the severity of risks related to sleep apnea.
The article looks at some of the biggest potential risks. It talks about how certain anesthetics are much more likely to lead to upper airway collapse (induced apnea) than others, and how people who are already at risk for stroke and other types of blood vessel blockage may find those risks increased by surgical anesthesia. However, they don’t endorse a specific level of risk.
Essentially, the doctors conclude that we don’t know how serious the risks related to sleep apnea really are. They cite several studies that show significantly increased risks, then several others that show significantly diminished risks, and briefly discuss the possible protective effects of sleep apnea (which is deserving of its own blog in the future). They also say that because of the complicated nature of sleep apnea, we are unlikely to ever be able to conduct a study that will really illuminate the true case of sleep apnea and its risks in the surgical environment.
So, they say, we have to work with the poor estimates we currently have and attempt to construct an approach that is prepared to deal with the worst-case scenario.
A Sensible Approach to Management
The Harvard researchers note that although up to 80% of surgical populations may have undiagnosed sleep apnea, there are no standard guidelines for dealing with sleep apnea patients who are having surgery. Since it’s impossible to schedule a sleep test for every surgical patient, they say, screening quizzes should be used instead. In addition to the standard STOP BANG protocol, they recommend their own Score for Preoperative prediction of Obstructive Sleep Apnea (SPOSA), which is built around indicators that should be in a patient’s electronic record, allowing doctors to screen patients without the need for another preoperative exam.
Patients who are known to have sleep apnea and are currently undergoing CPAP, should continue treatment in the perioperative environment, but under the supervision of a respiratory therapist to ensure maximum effectiveness. This, they say, can help reduce the risk of perioperative complications. Presumably, this is true of oral appliances as well.
Patients who are undiagnosed but at mild or moderate risk should be carefully observed with proper care taken to avoid the potential risks. Patients who are undiagnosed but at very high risk for sleep apnea may benefit from a consultation with a sleep doctor before surgery. This could potentially allow them to start sleep apnea treatment before surgery, hopefully reducing their risks.
An essential factor to remember is that undiagnosed sleep apnea is potentially more dangerous than diagnosed sleep apnea, and that treatment may potentially reduce or eliminate your risk. If you think you might have sleep apnea, there is no better time than today to seek a definitive answer. Please call (402) 493-4175 for an appointment with an Omaha sleep dentist at the Advanced Dental Sleep Treatment Center.