Perioperative Care of the Orthopedic Patient with Sleep-Disordered Breathing: Obstructive Sleep Apnea

Obstructive sleep apnea presents a well-recognized driver of perioperative complications. Considering the implications of this condition, coupled with the high prevalence particularly in orthopedic surgery, the adequate perioperative identification and management of obstructive sleep apnea is increasingly becoming a priority in clinical practice and scientific research. The current body of evidence and existent guideline recommendations for the perioperative setting emphasize the need for the implementation of perioperative risk management strategies to increase patient safety in this patient population. Obstructive sleep apnea-related complications are increasingly recognized in the legal field with prevalent litigation cases involving death and anoxic brain injury due to airway management complications and respiratory failure. Moreover, critical life-threatening OSA-related complications are often deemed as preventable with a systematic and cautious approach to perioperative care. This chapter focuses on current evidence, knowledge and clinical recommendations in respect to the perioperative care of surgical patients at risk or diagnosed with OSA.