Perioperative Management of the Sleep Apnea Patient. Grand Rounds June 6, 2007 Richard Browning, M.D. Goals. Review Incidence Define OSA & OSH Learn how to diagnose Understand the pathophysiology Develop a plan for pre-, intra- and post-op management. Incidence.
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Perioperative Management of the Sleep Apnea Patient
June 6, 2007
Richard Browning, M.D.
4% of men & 2% of women
Snoring AHI > 5 AHI > 10 AHI > 15
Age (Yrs) (%) (%) (%) (%)
<25 14 10 2 0
26-50 41 26 15 0
>50 46 61 50 36
AHI = Apnea Hypopnea Index
Anatomy of the Obstructed Airway
Exam: Tonsillar Hypertrophy
Sleep with Sleep Apnea
Child’s Enlarged Palatine & Adenoidal Tonsils
Patient With the Crowded Oropharynx
Guilleminault C et al. Sleep Apnea Syndromes. New York: Alan R. Liss, 1978.
What Happens with Normal Sleep?
Physiologic Consequences of OSA
Awake: Small airway + neuromuscular compensation
Hyperventilate: correct hypoxia & hypercapnia
Loss of neuromuscular compensation
Decreased pharyngeal muscle activity
Pharyngeal muscle activity restored
Arousal from sleep
Increased ventilatory effort
Hypoxia & Hypercapnia
Excessive Daytime Sleepiness