A Rude Awakening — The Perioperative Sleep Apnea Epidemic

In this editorial published in the New England Journal of Medicine, Dr. Memtsoudis and colleagues highlight and discuss the pressing issues that face physicians, patients and the health care system in respect to the topic of perioperative sleep apnea. The authors argue that given the staggering numbers of surgeries performed in the United States and the high proportion of patients with diagnosed and undiagnosed sleep apnea in the system, the lack of research and evidence based practice is no longer sustainable. They point toward the fact that sleep apnea may affect up to one fourth of the almost 50 Million surgical patients per year, thus creating an urgent need for attention to the subject. They further discuss the high cost associated with non-evidence based treatment strategies employed today and put in place to address concerns of patient safety and point to the dilemmas this practice causes from a medical, legal and financial perspective. Finally, the authors call for attention to the matter by proposing more funding and collaboration between stakeholders for related research, and suggest that non-traditional approaches such as practice based evidence studies may be needed to answer pressing questions.

Does Auto-Titrating Positive Airway Pressure Therapy Improve Postoperative Outcome in Patients at Risk for Obstructive Sleep Apnea Syndrome? A Randomized Controlled Clinical Trial

O’ Gorman and colleagues from Mayo hypothesized that APAP would shorten hospital stay and reduce postoperative complications in patients at high-risk but previously untreated for OSA with high– or low-risk grouping determined on the basis of the Flemons’ sleep apnea clinical score or SACS. Low-risk patients received standard care. High-risk patients were randomized to receive standard care or postoperative APAP. They enrolled 52 patients in the low-risk group, 43 were randomized to standard care and 43 to APAP. There were no significant differences in the length of stay (P = .65) or any of the secondary end points between the randomized groups. These results were unexpected and not explained by low compliance with a median APAP use of 373 min on the first postoperative night although the median use during the entire postoperative period fell to 185 min per night. The question emerging from this study is whether starting APAP before hospital admission would change outcomes?