[What significance does the obstructive sleep apnea syndrome have postoperatively or in the intensive care unit?]

Paraoperative change of sleep-disordered breathing in healthy snorers and sleep apnea patients compared to preoperative values

BACKGROUND

Patients with sleep-disordered breathing often show upper airway narrowing due to anatomical factors, which can be treated surgically. The paraoperative risk for sleep apnea patients is discussed from different points of view. We studied the effects of general anesthesia which is mainly used for surgery on the degree of disordered breathing.

METHODS

After two nights of polysomnographie 20 healthy subjects with snoring, light or severe sleep apnea were scheduled for surgery of the nose, the paranasal sinuses, the tonsils and/or the soft palate. A common screening device for disordered breathing was installed preoperatively. The raw data for snoring, oxygen saturation, heart rate and body position were edited visually in order to match them with polysomnography. Preoperative results were compared to the four hours following extubation and the first postoperative night.

RESULTS

Neither the respiratory disturbance indexes (RDI) nor the oxygen saturations nor the times of snoring differed significantly during the three examinations. Worsening was only found in the subgroup with predominantly mixed apnea. There was only one patient with a modified uvulo-palato-pharyngoplasty(UPPP) who had to be reintubated twelve hours after surgery due to massive oropharyngeal swelling. Patients without palatal surgery did not show any complications.

CONCLUSION

According to our experience surgically treated sleep apnea patients without any other cardiopulmonary disease may be kept in the general ENT ward. After oropharyngeal surgery intensive wound controls are required.