This survey shows that outpatient surgery for patients with sleep apnea is common practice in Germany. It is also performed when patients have moderate or severe OSAS and for respiratory tract surgery. This means that the management of OSA patients in Germany does not conform to the ASA OSA guidelines.
Sleep disordered breathing and its symptoms have been associated with a multitude of fetal and maternal complications including gestational hypertensive disorders, gestational diabetes and possibly pre-term labour and other markers of alterations in fetal wellbeing. The disease remains underdiagnosed in the general population but likely also in pregnancy, mostly because providers do not appropriately screen for the disorder. This case series describes patients with diagnoses such as chronic hypertension, pre-eclampsia, pulmonary hypertension, nocturnal asthma and panic attacks, who were diagnosed with sleep disordered breathing and offered treatment with CPAP during pregnancy.
An audit of 90 anesthetized patients undergoing bag-mask ventilation revealed a 34% incidence of EXPIRATORY upper airway obstruction due to the soft palate forming a one-way valve that allowed gas to enter the lung through the nose but prevented exhalation via this route. Expiratory obstruction resulted in breath-stacking and was cured by removing the mask intermittently and allowing the mouth to open.