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Obstructive Sleep Apnea (OSA) and Surgery: What are the Risks? PATIENT IDENTIFICATION What is Obstructive Sleep Apnea? Obstructive sleep apnea (OSA) is a common sleep disorder. With OSA, breathing pauses during sleep due to a blocked airway. The pause in breathing is called ‘apnea’ or an ‘apneic spell’. People with OSA often have apneic spells that last more than 10 seconds. They may have as many as 20-60 events every hour. This causes them to lose oxygen. Their brain awakens their body so they can start breathing again. Normal airway What causes OSA? There are several possible causes of OSA: • Muscles of the throat and tongue relax during sleep • Born with a narrow airway, short lower jaw, or large tongue • Overweight: extra fat around the airway causes it to close off • Enlarged tonsils or adenoids What are the signs of OSA? • Snoring • Apnea or gasping while sleeping (often noticed by sleep partner) • Waking up often during sleep • Daytime sleepiness Airway in a person with sleep apnea Is OSA harmful to my health? Who is at risk for OSA? There are many health risks that may result from untreated OSA. Some of them include: You are at risk for OSA if you: • High blood pressure • Are overweight • Heart Attack • Have high blood pressure • Stroke • Are male • Irregular heart beat (arrhythmia) • Are over 50 years old • Coronary artery disease • Are male with a neck size of 17 inches or more • Car crashes (from falling asleep while driving) • Are female with a neck size of 16 inches or more • Increased risk after surgery 1 of 2 Are there other treatment options? Other forms of treatment depend on the cause and have varying degrees of success. These include: • A dental device to keep jaw forward during sleep • Nasal valves to slow the out-breath to increase pressure in the throat (and perhaps keep it open) Loud snoring is a classic sign of OSA How is OSA Diagnosed? There are two screening tools that are used to see if you might have OSA. STOP-BANG checks for signs and risk factors as discussed earlier (overweight, high blood pressure, etc.). The Epworth Sleepiness Scale looks at your level of daytime sleepiness. If you are found to be at high risk for OSA, your provider will refer you to a sleep center for a sleep study. During a sleep study, various tests are done while you sleep. These tests look at the following: • Brain waves • Breathing effort • Surgery (used with severe OSA) to correct problems with face structures (rare and only when other treatments have not helped) How does having OSA increase my risk after surgery? Anesthesia and pain medications sedate you and relax your airway muscles. The effects of anesthesia can linger for a day or so after surgery. Combine that with pain medications, and you are likely to have more and longer apneic spells. If left unchecked, these can lead to serious health problems and even death. During surgery and recovery, you are constantly being watched. However, after you go to your hospital room or home (with a Same Day Surgery), you are not being watched all the time. This is the time when you are most at risk following surgery. • Oxygen levels How can I decrease my surgery risk if I have OSA? • How the above results vary based on body position and stage of sleep. 1. Primary care providers (PCP) screen for OSA. • Air flow through the nose and mouth What is the treatment for OSA? The goal of treatment for OSA is to keep the airway open so breathing does not stop during sleep. The most common and effective treatment for OSA is Continuous Positive Airway Pressure (CPAP). With CPAP, air is constantly blown into the airway by a pump and tight-fitting face mask. Although it takes some getting used to, most people adjust to it, especially after getting better sleep. Is there anything I can do myself to help treat OSA or reduce my risk? Here is how we help decrease your risk with surgery: 2. If you are found to be at risk for OSA, you are referred to a sleep center to have a sleep study done. Ideally this will be done before your surgery. 3. If you are diagnosed with OSA, you will be fitted with a CPAP mask and machine to use whenever you are asleep. 4. You will be asked to bring in your mask and machine for use while you are in the hospital. 5. You will be monitored carefully during your stay. When you are discharged, you will be reminded to use your CPAP machine whenever you are asleep. Lifestyle changes may help mild OSA: • Weight loss • Not sleeping on your back • Avoiding alcohol and sedatives 6245PH 12/2012 2 of 2