Surgical risk and the preoperative evaluation and management of adults with obstructive sleep apnea shoulder bone spur surgery recovery time

Obstructive sleep apnea (OSA) is increasing in prevalence [ 1,2], and the number of perioperative patients with OSA is likely to continue to rise in parallel with the increase in obesity [ 2-4]. OSA increases the risks of perioperative complications and should be suspected, recognized, and managed in the perioperative period to minimize postoperative morbidity and mortality [ 5].

The preoperative evaluation and management of patients with known or suspected OSA are reviewed here. The intraoperative and postoperative management of patients with OSA and preoperative evaluation of obese patients are discussed separately. (See Intraoperative management of adults with obstructive sleep apnea and Postoperative management of adults with obstructive sleep apnea and Preanesthesia medical evaluation of the obese patient.)


The prevalence of OSA in surgical patients is unclear. Using International Classification of Disease-9 codes, the prevalence has been estimated to be as high as 7 to 10 percent [ 6-8]. However, rates may be as high as 70 percent in high-risk populations such as patients undergoing bariatric surgery [ 9,10].

Many patients with OSA are undiagnosed at the time of surgery [ 11,12]. In one 2012 study, over 60 percent of surgical patients with moderate to severe OSA confirmed by polysomnography were not identified as having OSA during preoperative clinical evaluation by surgeons or anesthesiologists [ 11]. Similarly, the diagnosis of obesity hypoventilation syndrome (OHS) is frequently unknown at the time of surgery [ 13]. Consequently, a high level of suspicion for OSA and OHS should be maintained, particularly in high-risk patients. (See Clinical manifestations and diagnosis of obesity hypoventilation syndrome, section on ‘Risk factors’.)

Patients with OSA have a two- to fourfold higher risk for perioperative complications compared with patients without OSA [ 5-7,13-22]. Respiratory complications (desaturation, respiratory failure) are the most common. Others include difficulty with airway management, cardiovascular complications, and postoperative delirium, all leading to higher resource utilization.

Obstructive sleep apnea (OSA) is increasing in prevalence [ 1,2], and the number of perioperative patients with OSA is likely to continue to rise in parallel with the increase in obesity [ 2-4]. OSA increases the risks of perioperative complications and should be suspected, recognized, and managed in the perioperative period to minimize postoperative morbidity and mortality [ 5].

The preoperative evaluation and management of patients with known or suspected OSA are reviewed here. The intraoperative and postoperative management of patients with OSA and preoperative evaluation of obese patients are discussed separately. (See Intraoperative management of adults with obstructive sleep apnea and Postoperative management of adults with obstructive sleep apnea and Preanesthesia medical evaluation of the obese patient.)

The prevalence of OSA in surgical patients is unclear. Using International Classification of Disease-9 codes, the prevalence has been estimated to be as high as 7 to 10 percent [ 6-8]. However, rates may be as high as 70 percent in high-risk populations such as patients undergoing bariatric surgery [ 9,10].

Many patients with OSA are undiagnosed at the time of surgery [ 11,12]. In one 2012 study, over 60 percent of surgical patients with moderate to severe OSA confirmed by polysomnography were not identified as having OSA during preoperative clinical evaluation by surgeons or anesthesiologists [ 11]. Similarly, the diagnosis of obesity hypoventilation syndrome (OHS) is frequently unknown at the time of surgery [ 13]. Consequently, a high level of suspicion for OSA and OHS should be maintained, particularly in high-risk patients. (See Clinical manifestations and diagnosis of obesity hypoventilation syndrome, section on ‘Risk factors’.)

Patients with OSA have a two- to fourfold higher risk for perioperative complications compared with patients without OSA [ 5-7,13-22]. Respiratory complications (desaturation, respiratory failure) are the most common. Others include difficulty with airway management, cardiovascular complications, and postoperative delirium, all leading to higher resource utilization.