LAUSR

Obstructive sleep apnea (OSA) is a chronic condition of sleepdisordered breathing, characterized by upper airway obstruction, and intermittent episodes of apnea and hypopnea during sleep. It is an increasingly prevalent problem affecting 9% to 38% of adults above 18 years old in the general population, but it may remain unrecognized. Unrecognized severe OSA has been associated with an increased risk of major complications, including postoperative myocardial injury, stroke, and cardiac death in surgical patients. Patients with OSA exhibit similar characteristics as those with established difficult airways, which poses a significant problem for perioperative management and can result in severe complications including hypoxic brain damage and death. Both groups of patients are associated with morphological changes in the airway, where there is an increased risk of pharyngeal collapsibility due to the increased soft tissue deposition around the pharyngeal airway and increased visceral fat causing reduction of lung volume. In addition, patients with OSA are highly dependent on physiological neuromuscular activity to maintain airway patency and ventilation, which can be significantly depressed during deep sleep and anesthesia. Due to the complexity of perioperative airway and anesthetic management of patients with OSA, guidelines and recommendations have been published by major international societies to guide anesthetic management of these susceptible patients. This review seeks to provide a comprehensive review of (1) the physiological and morphologic airway features in patients with OSA, (2) the current evidence of the relationship between OSA and the difficult airway, and (3) the recommended perioperative management for the surgical patient with OSA.