Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea.

This article has been selected for the Anesthesiology CME Program. After reading the article, go to http:// www.asahq.org/journal-cme to take the test and apply for Category 1 credit. Complete instructions may be found in the CME section at the back of this issue. PRACTICE guidelines are systematically developed recommendations that assist the practitioner and patient in making decisions about health care. These recommendations may be adopted, modified, or rejected according to clinical needs and constraints. Practice guidelines are not intended as standards or absolute requirements. The use of practice guidelines cannot guarantee any specific outcome. Practice guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. They provide basic recommendations that are supported by analysis of the current literature and by a synthesis of expert opinion, open forum commentary, and clinical feasibility data.

[1]  L. Ferini-Strambi,et al.  Habitual snoring with and without obstructive sleep apnoea: the importance of cephalometric variables. , 1992, Thorax.

[2]  J. Szalai,et al.  Are history and physical examination a good screening test for sleep apnea? , 1991, Annals of internal medicine.

[3]  C L Marcus,et al.  Obstructive sleep apnea in children with Down syndrome. , 1991, Pediatrics.

[4]  G Djupesland,et al.  Cephalometric analysis in patients with obstructive sleep apnoea syndrome. , 1989, The Journal of Laryngology & Otology.

[5]  T. Lyberg,et al.  Obstructive sleep apnoea: a cephalometric study. Part II. Uvulo-glossopharyngeal morphology. , 1995, European journal of orthodontics.

[6]  P. L'Estrange,et al.  The cephalometric morphology of patients with obstructive sleep apnoea (OSA). , 1996, European journal of orthodontics.

[7]  H. Mitani,et al.  Relationship between cephalometric characteristics and obstructive sites in obstructive sleep apnea syndrome. , 2009, The Angle orthodontist.

[8]  G Djupesland,et al.  Cephalometric analysis in patients with obstructive sleep apnoea syndrome. , 1989, The Journal of Laryngology & Otology.

[9]  V. Somers,et al.  Investigating the relationship between stroke and obstructive sleep apnea. , 1996, Stroke.

[10]  D. Hillman,et al.  Association of sleep apnoea with myocardial infarction in men , 1990, The Lancet.

[11]  B. Sanner,et al.  Effect of continuous positive airway pressure therapy on 24-hour blood pressure in patients with obstructive sleep apnea syndrome. , 2002, American journal of hypertension.

[12]  J Okeson,et al.  Effect of sleep position on sleep apnea and parafunctional activity. , 1986, Chest.

[13]  L. Andersson,et al.  Cephalometric analysis of permanently snoring patients with and without obstructive sleep apnea syndrome. , 1991, International journal of oral and maxillofacial surgery.

[14]  T. Young,et al.  The occurrence of sleep-disordered breathing among middle-aged adults. , 1993, The New England journal of medicine.

[15]  C W Whitney,et al.  Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. , 2001, American journal of respiratory and critical care medicine.

[16]  S. Redline,et al.  Upright and supine cephalometric evaluation of obstructive sleep apnea syndrome and snoring subjects. , 2009, The Angle orthodontist.

[17]  R. Gliklich,et al.  Screening for Obstructive Sleep Apnea in Patients Presenting for Snoring Surgery , 1996, The Laryngoscope.

[18]  N J Douglas,et al.  Neck and total body fat deposition in nonobese and obese patients with sleep apnea compared with that in control subjects. , 1998, American journal of respiratory and critical care medicine.

[19]  M. Kryger,et al.  Sleep apnea and body position during sleep. , 1988, Sleep.

[20]  M Partinen,et al.  Obstructive sleep apneic patients have craniomandibular abnormalities. , 1986, Sleep.

[21]  J. Vangilder,et al.  Perioperative Management and Surgical Outcome of the Acromegalic Patient with Sleep Apnea: 70 , 1995, Neurosurgery.

[22]  A. Lienhart,et al.  Difficult intubation and obstructive sleep apnoea syndrome. , 1994, British journal of anaesthesia.

[23]  K. Casey,et al.  Late postoperative nocturnal dips in oxygen saturation in patients undergoing major abdominal vascular surgery , 1992, Anaesthesia.

[24]  D. Pevernagie,et al.  Relations between sleep stage, posture and effective nasal CPAP levels in OSA. , 1992, Sleep.

[25]  U. Brandenburg,et al.  Morphology of the viscerocranium in obstructive sleep apnoea syndrome--cephalometric evaluation of 400 patients. , 1994, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[26]  J. Hedner,et al.  Impact of obstructive sleep apnea and sleepiness on metabolic and cardiovascular risk factors in the Swedish Obese Subjects (SOS) Study. , 1995, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[27]  Y. Itasaka,et al.  The influence of sleep position and obesity on sleep apnea , 2000, Psychiatry and clinical neurosciences.

[28]  C Guilleminault,et al.  A Predictive Morphometric Model for the Obstructive Sleep Apnea Syndrome , 1997, Annals of Internal Medicine.

[29]  P. Gay,et al.  Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study. , 2001, Mayo Clinic proceedings.

[30]  Charles E. Smith,et al.  Perioperative complications during use of an obstructive sleep apnea protocol following surgery and anesthesia. , 2007, Anesthesia and analgesia.

[31]  J R Galvin,et al.  Obstructive sleep apnea: diagnosis with ultrafast CT. , 1989, Radiology.

[32]  H. Sakakibara,et al.  Cephalometric abnormalities in non-obese and obese patients with obstructive sleep apnoea. , 1999, The European respiratory journal.

[33]  K. Kubo,et al.  Cephalometric analysis in obese and nonobese patients with obstructive sleep apnea syndrome. , 2003, Chest.

[34]  C. Marcus,et al.  Use of nasal continuous positive airway pressure as treatment of childhood obstructive sleep apnea. , 1995, The Journal of pediatrics.

[35]  A. Agustí,et al.  Patients with obstructive sleep apnea exhibit genioglossus dysfunction that is normalized after treatment with continuous positive airway pressure. , 1999, American journal of respiratory and critical care medicine.

[36]  T. Lyberg,et al.  Obstructive sleep apnoea: a cephalometric study. Part I. Cervico-craniofacial skeletal morphology. , 1995, European journal of orthodontics.

[37]  K. Strohl,et al.  Using the Berlin Questionnaire To Identify Patients at Risk for the Sleep Apnea Syndrome , 1999, Annals of Internal Medicine.

[38]  D. Caldarelli,et al.  Clinical Predictors of Obstructive Sleep Apnea , 1999, The Laryngoscope.

[39]  K. Bloch,et al.  Anesthetic management of a patient with obstructive sleep apnea syndrome and difficult airway access. , 1995, Journal of clinical anesthesia.

[40]  D. Caldarelli,et al.  A comparative study of treatments for positional sleep apnea. , 1991, Sleep.

[41]  C. Guilleminault,et al.  Cephalometric analyses and flow-volume loops in obstructive sleep apnea patients. , 1983, Sleep.

[42]  The role of oxygen saturation measurement and body mass index in distinguishing between non-apnoeic snorers and patients with obstructive sleep apnoea syndrome. , 2002, Clinical otolaryngology and allied sciences.

[43]  M. Dyken,et al.  Prospective polysomnographic analysis of obstructive sleep apnea in down syndrome. , 2003, Archives of pediatrics & adolescent medicine.

[44]  J. Krieger,et al.  Craniofacial characteristics in patients with obstructive sleep apneas syndrome. , 1988, The Cleft palate journal.

[45]  Peretz Lavie,et al.  Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study , 2000, BMJ : British Medical Journal.

[46]  R. Cartwright,et al.  Effect of sleep position on sleep apnea severity. , 1984, Sleep.

[47]  Negar Ahmadi,et al.  The Berlin questionnaire for sleep apnea in a sleep clinic population: relationship to polysomnographic measurement of respiratory disturbance , 2008, Sleep and Breathing.

[48]  A C Bryan,et al.  Upper airway morphology in patients with idiopathic obstructive sleep apnea. , 2015, The American review of respiratory disease.

[49]  R. Blanks,et al.  Cephalometric analysis for diagnosis and treatment of obstructive sleep apnea , 1988, The Laryngoscope.

[50]  T. Okada,et al.  High incidence of sleep apnea syndrome in a male diabetic population. , 1991, Diabetes research and clinical practice.

[51]  C. Guilleminault,et al.  Two-point palatal discrimination in patients with upper airway resistance syndrome, obstructive sleep apnea syndrome, and normal control subjects. , 2002, Chest.

[52]  J. Krieger,et al.  Cephalometric evaluation of pharyngeal obstructive factors in patients with sleep apneas syndrome. , 1990, The Angle orthodontist.

[53]  R. Cartwright,et al.  The effects of sleep posture and sleep stage on apnea frequency. , 1991, Sleep.

[54]  Xihong Lin,et al.  Obstructive sleep apnea in epilepsy patients: the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ) is a useful screening instrument for obstructive sleep apnea in a disease-specific population. , 2003, Sleep medicine.

[55]  K. Franklin,et al.  Physical findings in the upper airways related to obstructive sleep apnea in men and women , 2007, Acta oto-laryngologica.

[56]  M. Güven,et al.  Evaluation of clinical parameters in patients with obstructive sleep apnea and possible correlation with the severity of the disease , 2001, European Archives of Oto-Rhino-Laryngology.

[57]  A. Gorin,et al.  Undiagnosed sleep apnea in patients with essential hypertension. , 1985, Annals of internal medicine.

[58]  G. Maislin,et al.  Physical findings and the risk for obstructive sleep apnea. The importance of oropharyngeal structures. , 2000, American journal of respiratory and critical care medicine.

[59]  R. Pandey,et al.  Validation of the modified Berlin questionnaire to identify patients at risk for the obstructive sleep apnoea syndrome. , 2006, The Indian journal of medical research.

[60]  B. Steinberg,et al.  The cranial base in obstructive sleep apnea. , 1995, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[61]  L. Ferini-Strambi,et al.  Craniofacial Cephalometric Evaluation in Habitual Snorers with and without Obstructive Sleep Apnea , 1993, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[62]  A I Pack,et al.  Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. , 1995, American journal of respiratory and critical care medicine.

[63]  A I Pack,et al.  Magnetic resonance imaging of the upper airway structure of children with obstructive sleep apnea syndrome. , 2001, American journal of respiratory and critical care medicine.

[64]  L. Olson,et al.  Prediction of sleep‐disordered breathing by unattended overnight oximetry , 1999, Journal of sleep research.

[65]  G. Ferretti,et al.  Relationship between body mass index, age and upper airway measurements in snorers and sleep apnoea patients. , 1996, The European respiratory journal.

[66]  P. Szmuk,et al.  Increased body mass indexper se is not a predictor of difficult laryngoscopy , 2003, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[67]  A. Pack,et al.  Upper airway size analysis by magnetic resonance imaging of children with obstructive sleep apnea syndrome. , 2003, American journal of respiratory and critical care medicine.