therapy is highly beneficial. In one, OSA patients given a prescription
for CPAP before surgery had significantly reduced risk of cardiovas-
cular adverse events, compared with patients with undiagnosed OSA.
The second found that untreated OSA patients had significantly
greater cardiopulmonary complication rates than those with pre-
scribed PAP therapy. Untreated OSA patients also had significantly
greater myocardial infarction rates and significantly more unplanned
reintubations.
CPAP-adherent patients should continue to wear their devices at
appropriate times both pre-operatively and post-operatively, as acute
withdrawal of such therapy has been shown to result in recurrence of
OSA and OSA-related symptoms within 1 to 3 days and physiologic
derangements within 2 weeks.
Patients using alternative therapies for OSA should also be encour-
aged to continue using their therapy in the perioperative setting.
• Exercise caution with non-compliant OSA patients. For patients
who've been diagnosed with OSA but who are non-adherent or poorly
adherent to positive airway pressure therapy, pre-operative cardiopul-
monary evaluation is recommended and, as noted previously, so is
delaying surgery in the presence of hypoventilation or pulmonary
hypertension, or resting hypoxemia in the absence of other known
cardiopulmonary disease.
• Educate untreated and suspected OSA patients. Although it's
clear that OSA can negatively influence outcomes, many procedures
are low-risk, and, in part because screening tools aren't completely
accurate, ultimately only a small percentage of patients identified as
high risk have increased perioperative complications.
For patients with untreated or suspected OSA, discuss the risks and
benefits of surgery, and consider the multiple relevant factors, such as
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