Do Sleep Apnea Patients Need Special Care After Surgery?

People with sleep apnea may be at increased risk for complications if they have surgery, but little is known about how to reduce this risk, experts say.

What's more, many people don't know they have sleep apnea, so there may be a large population that is unknowingly at higher risk for surgery complications.

Doctors are calling for more research into the effects of sleep apnea on surgery recovery in order to better understand how to care for these patients and find out which treatments work best.

"There's this huge problem out there, and really no good answer," Dr. Stavros G. Memtsoudis, an anesthesiologist at Hospital for Special Surgery in New York, said about the issue.

Sleep apnea is a condition in which people experience pauses in breathing during sleep. As much as 25 percent of men and 10 percent of women in the United States have the condition, Memtsoudis said. Recent studies show people with sleep apnea are at increased risk for complications, particularly lung and breathing problems, after surgery.

Although some organizations say that patients with sleep apnea need special treatment after surgery -- including treatments to help keep the patient's airways open -- there's not much evidence that these treatments work to reduce complications, Memtsoudis said.

And though patients with diabetes and coronary artery disease are generally treated before surgery to make sure they are fit for the operation, it's not clear whether the same needs to be done for sleep-apnea patients, Memtsoudis said.

Some studies suggest that up to 80 percent of people undergoing surgery don't know they have sleep apnea, and the condition is often discovered in the days leading up to surgery. When this happens, doctors don't know whether to cancel the surgery and have the patient treated for the apnea first, or to go ahead with the surgery, even if the risk of complications may be increased, Memtsoudis said.

Memtsoudis and colleagues plan to conduct a study to learn which patients with sleep apnea are most at risk for complications after surgery. It is unclear whether only patients with severe sleep apnea are at risk, or if those with milder symptoms are also affected. It's also unclear whether certain conditions, such as obesity and diabetes, which often occur with sleep apnea, may affect the risk.

Further research is needed to determine which treatments work best for sleep-apnea patients during and after surgery. Some studies suggest that using regional anesthesia (anesthesia that affects one area of the body), instead of general anesthesia (anesthesia that makes you unconscious), during surgery on sleep-apnea patients may reduce their risk of complications, Memtsoudis said.

Until they know the results of this further research, doctors should be aware of the issue, and hospitals should consider creating standard protocols for how to manage sleep-apnea patients who need surgery, Memtsoudis said. The protocols will depend on the resources the hospital has, but at a minimum, doctors may want to keep a special eye on these surgery patients, he said.

Memtsoudis and colleagues wrote about this topic in an article published in the June 20 issue of the New England Journal of Medicine.