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May 14, 2019

Unrecognized Obstructive Sleep Apnea and Postoperative Cardiovascular Complications: A Wake-up Call

Author Affiliations
  • 1Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
  • 2Society of Anesthesia and Sleep Medicine, Milwaukee, Wisconsin
  • 3Anesthesia and Health Policy and Research, Weill Cornell Medical College, New York, New York
  • 4Department of Anesthesiology, Hospital for Special Surgery, New York, New York
JAMA. 2019;321(18):1774-1776. doi:10.1001/jama.2019.4781

In the United States, obstructive sleep apnea (OSA) affects 14% of adult men and 5% of adult women, with higher rates among obese individuals and older adults.1 The majority of individuals with OSA remain undiagnosed.2,3 Although OSA has repeatedly been associated with unfavorable long-term cardiovascular outcomes,4 it is increasingly recognized that patients with OSA are at risk for adverse events in the postoperative setting.5,6 Perioperative clinicians have traditionally equated the presence of OSA with complications affecting the respiratory system, but based on a small number of mostly retrospective studies, it is unclear whether patients with unrecognized OSA are at higher risk of postoperative cardiovascular events. In addition, because most patients with OSA will be undiagnosed at the time of surgery, questions remain regarding the importance of identifying this population preoperatively, as well as of risk-stratifying individuals for clinically relevant adverse outcomes. Quality data are needed to address this issue, because the results could significantly influence clinical care pathways for patients undergoing surgery.