Obstrüktif uyku apne sendromu ve anestezi

Obstrüktif uyku apne sendromu, uyku ile ilişkili bir solunum hastalığıdır. Prevalansı genel populasyonda %2-25 arasındadır. Horlama, apne periyotları, fragmante uyku ve gündüz uykulu olma hali en sık semptomlarıdır. Obstrüktif uyku apne sendromunun; metabolik problemler, hipertansiyon, konjestif kalp yetmezliği ve serebrovasküler olaylara neden olarak mortaliteyi arttırdığı gösterilmiştir. Anestezik ilaçların üst havayolunda neden olduğu kollaps bu hastaları anesteziye duyarlı hale getirmektedir. Günümüzde anestezistler elektif cerrahi geçirmek üzere tanısı konmamış bir çok hastayla karşılaşabilmektedir. Bu hastaların anestezistler tarafından tanınarak gerekli önlemlerin alınması, perioperatif komplikasyon oranını ve mortaliteyi önemli oranda azaltacaktır. Bu derlemede, obstrüktif uyku apne sendromu olan hastaların tanınması ve anestezi yönetiminde dikkat edilmesi gereken noktaları vurgulamayı amaçladık.

Anahtar Kelimeler:

Obstrüktif uyku apnesi, anestezi, perioperatif komplikasyon

Obstructive sleep apnea syndrome and anesthesia

Obstructive sleep apnea syndrome is a sleep related breathing disorder. Its prevalence is % 2-25 in general population. Snoring, apnea periods, fragmented sleep and daytime sleepiness are the most common symptoms. It is demonstrated that obstructive sleep apnea syndrome increases the mortality by causing metabolic problems, hypertension, congestive heart failure and cerebrovascular events. Collapse in the upper airway that is contributed by anesthetic drugs make these patients more sensitive to anesthesia. Today, anesthesiologists may encounter many undiagnosed patients for elective surgeries. Recognition of these patients by the anesthesiologists and taking appropriate measures will decrease perioperative complication rates and mortality substantially. In this review, we aimed to emphasize the diagnosis of obstructive sleep apnea patients and topics to be considered in anesthesia management.

Keywords:

Obstructive sleep apnea, anesthesia, perioperative complication,

PDF

___

Vasu TS, Grewal R, Doghramji K. Obstructive sleep apnea syndrome and perioperative complications: a systematic review of the literature. J Clin Sleep Med 2012; 8: 199-207.
Gross JB, Bachenberg KL, Benumof JL, Caplan RA, Connis RT, Coté CJ, et al. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 2006; 104: 1081-93; quiz 1117.
Rosen CL. Obstructive sleep apnea syndrome (OSAS) in children: diagnostic challenges. Sleep 1996; 19: S274-S277.
Tregear S, Reston J, Schoelles K, Phillips B. Obstructive sleep apnea and risk of motor vehicle crash: systematic review and meta-analysis. J Clin Sleep Med 2009; 5: 573-581.
Sharma B, Owens R, Malhotra A. Sleep in congestive heart failure. Med Clin North Am 2010; 94: 447-464.
Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000; 342: 1378-1384.
Tasali E, Mokhlesi B, Van Cauter E. Obstructive sleep apnea and type 2 diabetes: interacting epidemics. Chest 2008; 133: 496-506.
Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V, et al. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005; 353: 2034-2041.
Loadsman JA, Hillman DR. Anaesthesia and sleep apnoea. Br J Anaesth 2001; 86: 254-266.
Porhomayon J, Leissner KB, El-Solh AA, Nader ND. Strategies in postoperative analgesia in the obese obstructive sleep apnea patient. Clin J Pain 2013; 29: 998-1005.
Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 2005; 28: 499- 521.
Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest 2010; 137: 711-719.
Ulualp SO. Snoring and obstructive sleep apnea. Med Clin North Am 2010; 94: 1047-1055.
Moos DD, Prasch M, Cantral DE, Huls B, Cuddeford JD. Are patients with obstructive sleep apnea syndrome appropriate candidates for the ambulatory surgical center? AANA J 2005; 73: 197-205.
Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances. American Sleep Disorders Association. Sleep 1995; 18: 511-513.
O'Sullivan RA, Hillman DR, Mateljan R, Pantin C, Finucane KE. Mandibular advancement splint: an appliance to treat snoring and obstructive sleep apnea. Am J Respir Crit Care Med 1995; 151: 194-198. 17. Hirshkowitz M, Sharafkhaneh A. Positive airway pressure therapy of OSA. Semin Respir Crit Care Med 2005; 26: 68-79.
Martínez-García MA, Soler-Cataluña JJ, Ejarque- Martínez L, Soriano Y, Román-Sánchez P, Illa FB, et al. Continuous positive airway pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. Am J Respir Crit Care Med 2009; 180: 36-41.
Park JG, Ramar K, Olson EJ. Updates on definition, consequences, and management of obstructive sleep apnea. Mayo Clinic proceedings 2011; 86: 549-54; quiz 554.
Tomfohr LM, Ancoli-Israel S, Loredo JS, Dimsdale JE. Effects of continuous positive airway pressure on fatigue and sleepiness in patients with obstructive sleep apnea: data from a randomized controlled trial. Sleep 2011; 34: 121-126.
Patino M, McAuliffe J, Francis L, Mohamed M. Obstructive sleep apnea syndrome: anesthetic concerns. Int Anesthesiol Clin 2012; 50: 41-53.
Kaw R, Pasupuleti V, Walker E, Ramaswamy A, Foldvary-Schafer N. Postoperative complications in patients with obstructive sleep apnea. Chest 2012; 141: 436-441.
Diffee PD, Beach MM, Cuellar NG. Caring for the patient with obstructive sleep apnea: implications for health care providers in postanesthesia care. J Perianesth Nurs 2012; 27: 329-340.
Gupta RM, Parvizi J, Hanssen AD, Gay PC. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study. Mayo Clinic proceedings 2001; 76: 897-905.
Liao P, Yegneswaran B, Vairavanathan S, Zilberman P, Chung F. Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study. Can J Anaesth 2009; 56: 819-828.
Hwang D, Shakir N, Limann B, Sison C, Kalra S, Shulman L, et al. Association of sleep-disordered breathing with postoperative complications. Chest 2008; 133: 1128-1134.
Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg 2003; 13: 676-683.
O'Keeffe T, Patterson EJ. Evidence supporting routine polysomnography before bariatric surgery. Obes Surg 2004; 14: 23-26.
Vasu TS, Doghramji K, Cavallazzi R, Grewal R, Hirani A, Leiby B, et al. Obstructive sleep apnea syndrome and postoperative complications: clinical use of the STOP-BANG questionnaire. Arch Otolaryngol Head Neck Surg 2010; 136: 1020-1024.
Chung F, Ward B, Ho J, Yuan H, Kayumov L, Shapiro C, et al. Preoperative identification of sleep apnea risk in elective surgical patients, using the Berlin questionnaire. J Clin Anesth 2007; 19: 130-134.
Seet E, Chung F. Management of sleep apnea in adults - functional algorithms for the perioperative period: Continuing Professional Development. Can J Anaesth 2010; 57: 849-864.
Connolly LA. Anesthetic management of obstructive sleep apnea patients. J Clin Anesth 1991; 3: 461-469.
American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2003; 98: 1269-1277.
Plunkett AR, McLean BC, Brooks D, Plunkett MT, Mikita JA. Does difficult mask ventilation predict obstructive sleep apnea? A prospective pilot study to identify the prevalence of osa in patients with difficult mask ventilation under general anesthesia. J Clin Sleep Med 2011; 7: 473-477.
Kurtipek O, Isik B, Arslan M, Unal Y, Kizil Y, Kemaloglu Y, et al. A study to investigate the relationship between difficult intubation and prediction criterion of difficult intubation in patients with obstructive sleep apnea syndrome. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences 2012; 17: 615- 620.
Hendolin H, Kansanen M, Koski E, Nuutinen J. Propofol-nitrous oxide versus thiopentone-isoflurane- nitrous
uvulopalatopharyngoplasty in patients with sleep apnea. Acta Anaesthesiol Scand 1994; 38: 694-698.
Patel A, Davidson M, Tran MCJ, Quraishi H, Schoenberg C, Sant M, et al. Dexmedetomidine infusion for analgesia and prevention of emergence agitation in children with obstructive sleep apnea syndrome
adenoidectomy. Anesth Analg 2010; 111: 1004-1010.
Dholakia C, Beverstein G, Garren M, Nemergut C, Boncyk J, Gould JC, et al. The impact of perioperative dexmedetomidine infusion on postoperative narcotic use and duration of stay after laparoscopic bariatric surgery. J Gastrointest Surg 2007; 11: 1556-1559.
Rosenberg J, Wildschiİdtz G, Pedersen MH, von Jessen F, Kehlet H. Late postoperative nocturnal episodic hypoxaemia and associated sleep pattern. Br J Anaesth 1994; 72: 145-150.
Ejnell H, Björkman R, Wåhlander L, Hedner J. Treatment of postoperative pain with diclofenac in uvulopalatopharyngoplasty. Br J Anaesth 1992; 68: 76- 80.
Göröcs TS, Lambert M, Rinne T, Krekler M, Modell S. Efficacy and tolerability of ready-to-use intravenous paracetamol solution as monotherapy or as an adjunct analgesic therapy for postoperative pain in patients undergoing elective ambulatory surgery: open, prospective study. Int J Clin Pract 2009; 63: 112-120.
Hullett BJ, Chambers NA, Pascoe EM, Johnson C. Tramadol vs morphine during adenotonsillectomy for obstructive sleep apnea in children. Paediatr Anaesth 2006; 16: 648-653.
Luscri N, Tobias JD. Monitored anesthesia care with
dexmedetomidine during magnetic resonance imaging in three children with trisomy 21 and obstructive sleep apnea. Paediatr Anaesth 2006; 16: 782-786.
Raghavendran S, Bagry H, Detheux G, Zhang X, Brouillette RT, Brown KA, et al. An anesthetic management protocol to decrease respiratory complications after adenotonsillectomy in children with severe sleep apnea. Anesth Analg 2010; 110: 1093-1101.
Chung F. It may be unsafe for patients with untreated severe OSA requiring postoperative narcotic to undergo ambulatory surgery. J Clin Sleep Med 2011; 7: 111; author reply 112-111; author reply 113.
Ankichetty S, Chung F. Considerations for patients with obstructive sleep apnea undergoing ambulatory surgery. Curr Opin Anaesthesiol 2011; 24: 605-611.
Seet E, Chung F. Obstructive sleep apnea: preoperative assessment. Anesthesiol Clin 2010; 28: 199-215. of ketamine and