Post-anesthesia care unit discharge for obstructive sleep apnea

OSA: obstructive sleep apnea; AHI: apnea-hypopnea index; PAP: positive airway pressure; ENT: ear nose and throat; BMI: body mass index; OHS: obesity hypoventilation syndrome; PACU: post-anesthesia care unit.

* PAP includes continuous PAP (CPAP), bilevel PAP (BiPAP), or auto-titrating CPAP. Nonadherence may be assessed by patient self report, which tends to overestimate adherence, or by data on the PAP data card. Nonadherence is usually defined as PAP use <4 hours per night.

¶ Significant OSA-related comorbidities include heart failure, arrhythmias, uncontrolled hypertension, cerebrovascular disease (eg, prior stroke, known carotid disease), uncontrolled diabetes.

Δ OHS is characterized by persistent daytime hypercapnia with PCO₂ >45 mmHg; overlap syndrome consists of OSA plus chronic obstructive pulmonary disease.

◊ Findings on sleep study that may predict postoperative respiratory complications include a high hypoxic burden (ie, >10% of time spent at SpO₂ <90%), or pathologic sleep hypoventilation (ie, PCO₂ >55 mmHg for ≥10 minutes).

§ Postoperative opioid and sedative requirement as indicated by the need for parenteral opioids or pain sedation mismatch (high pain and sedation scores concurrently) in the PACU, or high anticipated postoperative need.

¥ Recurrent PACU respiratory events: repeated oxygen desaturation to <90%, or bradypnea to <8 breaths/minute, or apnea lasting >10 seconds.

‡ Monitored bed: Environment with continuous pulse oximetry and the possibility of early medical intervention (eg, intensive care unit, step-down unit, or remote pulse oximetry with telemetry on surgical ward).