Kemal KİRAZ, Selahattin AKYOL, Abdurrahman SÖNMEZLER, Mustafa ÇÖRTÜK

Perioperative evaluation for the patients with obstructive sleep apnea syndrome

Obstrüktif uyku apne sendromu son yıllarda daha sık tan ı koyulanve önemi giderek daha iyi anla şılan yaygın bir sa ğlık problemidir.Bu sendroma sıklıkla obezite e şlik eder. Obstrüktif uyku apnesendromunda hipoksi ve bazen de ek olarak hiperkarbi olduğu, yine bu hasta grubunda kardiyovasküler problemlerin diğer kişilere göre daha sık oldu ğu bilinmektedir. İnvaziv iş lemler sırasındahastaya uygulanan anestezik maddeler ve analjezi için kullan ılan bazı ilaçlar obstrüktif uyku apne sendromunda bahsi geçen buhipoksi ve kardiyovasküler problemlerin artmasına neden olabilir. Bu derleme sa ğlık kurulu şlarına ula şım ın ve dolayısıyla cerrahiuygulamaların sayısın ın arttığı günümüzde bu hasta grubunda anestezi öncesi ve sonrası alınması gereken önlemler ve yaklaşımkonusunda klinisyenlere yardımc ı olabilece ği dü şüncesi ile haz ırlanm ıştır.

Obstrüktif uyku apne sendromu olan hastalarda perioperatif değerlendirme

Obstructive sleep apnea syndrome, that has been more frequently diagnosed lately and whose importance has been gradually under-stood better, is a widespread health problem. This syndrome has been accompanied by obesity frequently. In the obstructive sleepapnea syndrome, it has been known that hypoxia and sometimes hypercarbia additionally has been observed, nevertheless cardio-vascular problems have been observed more frequently in the aforementioned patient group in comparison with other individuals.Anesthetic substituents applied during the invasive operations and some medicine used for analgesia may cause the increase of theaforesaid hypoxia and cardiovascular problems in the obstructive sleep apnea syndrome. Nowadays, with the improvements inaccessing to health agencies and consequently with the increase in the number of surgical applications, this review has been pre-pared with the thought of helping to clinicians about the approach and the pre-anesthetic and post-anesthetic precautions requiredto be taken within the mentioned patient group.

PDF

___

1 Caples SM, Gami AS, Somers VK. Obstructive sleep apnea. Ann Intern Med 2005;1423:187-97.
2 Bahammam A, Delaive K, Ronald J, Manfreda J, Roos L, Kryger MH. Health care utilization in males with obstruc- tive sleep apnea syndrome two years after diagnosis and treatment. Sleep 1999;22:740-7.
3 He J, Kryger MH, Zorick FJ, Conway W, Roth T. Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. Chest 1988;94:9-14.
4 Kapur V, Strohl KP, Redline S, Iber C, OConnor G, Nieto J. Underdiagnosis of sleep apnea syndrome in U.S. com- munities. Sleep Breath 2002;62:49-54.
5 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;5611:819-28.
6. Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest 2010;1373:711-9.
7. Krieger J, Turlot JC, Mangin P, Kurtz D. Breathing during sleep in normal, young, and elderly subjects: hypopneas, apnoeas and correlated factors. Sleep 1983;6:108-20.
8. Finkel KJ, Searleman AC, Tymkew H, Tanaka CY, Saager L, Safer-Zadeh E, et al. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med 2009;107:753-8.
9. McNicholas WT, Ryan S. Obstructive sleep apnoea syn- drome: translating science to clinical practice. Respirology 2006;112:136-44.
10. 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;56:819-28.
11. 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 Clin Proc 2001;769:897-905.
12. Waters KA, McBrien F, Stewart P, Hinder M, Wharton S. Effects of OSA, inhalational anesthesia, and fentanyl on the airway and ventilation of children. J Appl Physiol 2002;925: 1987-94.
13. Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J Jr, et al. Practice parameters for the indica- tions for polysomnography and related procedures: an update for 2005. Sleep 2005;284:499-521.
14. Iber C, Ancoli-Israel S, Chesson A, Quan S. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications for the American Academy of Sleep Medicine. 1 st ed. Westchester: IL: American Academy of Sleep Medicine; 2007.
15. Centers for Medicare and Medicaid Services. Medicare National Coverage Determinations Manual. Chapter 1, part 4 (Section 200-310.1) Covarage Determinations. Accessed Date: 29 September 2014. Available from: www.cms.gov/ Regulations-and- Guidance/Guidance/Manual/down- loads/ncd103c1_Part4.pdf.
16. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999;1317:485-91.
17. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 2008;1085:812-21.
18. Ramachandran SK, Kheterpal S, Consens F, Shanks A, Doherty TM, Morris M, et al. Derivation and validation of a simple perioperative sleep apnea prediction score. Anesth Analg 2010;1104:1007-15.
19. Siyam MA, Benhamou D. Difficult endotracheal intubation in patients with sleep apnea syndrome. Anesth Analg 2002;954:1098-102.
20. Sajkov D, Cowie RJ, Thornton AT, Espinoza HA, McEvoy RD. Pulmonary hypertension and hypoxemia in obstructive sleep apnea syndrome. Am J Respir Crit Care Med 1994;1492:416-22.
21. Barst RJ, McGoon M, Torbicki A, Sitbon O, Krowka MJ, Olschewsky H, et al. Diagnosis and differential assessment of pulmonary arterial hypertension. J Am Coll Cardiol 2004;4312:40-7.
22. Atwood CW Jr, McCrory D, Garcia JG, Abman SH, Ahearn GS. American College of Chest Physicians Pulmonary artery hypertension and sleep-disordered breathing: ACCP evidence-based linical practice guidelines. Chest 2004;1261:72-7.
23. Delay JM, Sebbane M, Jung B, Nocca D, Verzilli D, Pouzeratte Y, et al. The effectiveness of noninvasive posi- tive pressure ventilation to enhance preoxygenation in morbidly obese patients: a randomized controlled study. Anesth Analg 2008;1075:1707-13.
24. Cartwright RD. Effect of sleep position on sleep apnea severity. Sleep 1984;72:110-4.
25. Brown KA, Laferrière A, Lakheeram I, Moss IR. Recurrent hypoxemia in children is associated with increased analge- sic sensitivity to opiates. Anesthesiology 2006;1054:665-9.
26. Gali B, Whalen FX, Schroeder DR, Gay PC, Plevak DJ. Identification of patients at risk for postoperative respirato- ry complications using a preoperative obstructive sleep apnea screening tool and postanesthesia care assessment. Anesthesiology 2009;1104:869-77.
27. Adesanya AO, Lee W, Greilich NB, Joshi GP. Perioperative management of obstructive sleep apnea. Chest 2010;138:1489-98.
28. Gross JB, Bachenberg KL, Benumof JL, Caplan RA, Connis RT, Coté CJ, et al. American Society of Anesthesiologists Task Force on Perioperative Management Practice guide- lines 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;1045:1081-93.
29. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term car- diovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with con- tinuous positive airway pressure: an observational study. Lancet 2005;3659464:1046-53.
30. Khayat RN, Abraham WT, Patt B, Pu M, Jarjoura D. In-hospital treatment of obstructive sleep apnea during decompensation of heart failure. Chest 2009;1364:991-7.