[Obstructive sleep apnea and anesthesia].

Even though the effects of surgery and anesthesia on sleep have not been completely defined yet, it is an irrefutable fact that the patients with sleep apnea could experience significant perioperative complications, in terms of common difficult airway problems, as well as prolonged emergence from anesthesia. Besides, there are strong evidences of correlation between sleep apnea and hypertension and other cardiovascular diseases. Preoperative questions about sleep, possible snoring, or excessive daytime sleepiness should become a routine part of preanesthesia evaluation, together with airway examination and thorough pulmonary and cardiovacular examination. However, the exact severity of the obstructive sleep apnea (OSA) could be precisely defined only by polysomnography. Every patient diagnosed with OSA, or with clinical suspicion of OSA, should be considered to have a difficult airway, until proven otherwise, and consequently has increased risk of anesthesia. The possible problems may arise during tracheal intubation, extubation, or with postoperative analgesia, since opioids increase the incidence of pharyngeal collapse. Whenever possible, regional anesthesia techniques should be used. On the other hand, by documenting every difficult airway management, difficult intubation or prolonged recovery, the anesthesiologists are in good position to effectively screen for OSA in population.