Featured Articles from May 2016

CPAP in the Perioperative Setting: Evidence of Support

The prevalence of OSA in surgical patients may be as high as 70%. These patients pose a significant clinical challenge to health-care professionals, and the lack of evidence behind the current guidelines recommendations and significant costs of guideline implementation have created a dilemma between potentially improved postoperative adverse events and increased health-care resource utilizations. This review examines the evidence regarding the use of CPAP in the perioperative period.

For surgical patients with OSA it is clear that those who are treated and adherent to CPAP should continue their CPAP in the postoperative period. Those patients with diagnosed OSA who are not adherent to therapy or undiagnosed OSA pose a more significant clinical challenge. CPAP has been shown to have beneficial effects on postoperative adverse events.

There are several barriers to effective diagnosis and treatment of OSA in the perioperative setting. In both clinical and research settings, a significant proportion of patients who may have suspected OSA refuse to undergo additional testing for establishing an OS diagnosis. Also, for those patients that actually are on home CPAP therapy only one third used their CPAP during the postoperative stay in the hospital.

Individual evaluation is important to determine the best course of action. Referral to sleep medicine for CPAP therapy may have to be taken in the absence of overwhelming evidence from RCTs in certain groups of patients. Patients with severe OSA, COPD or overlap syndrome, obesity hypoventilation syndrome, or pulmonary hypertension would definitely benefit from further evaluation and workup. Patients who have preoperative resting hypoxemia on room air with no known cardiopulmonary cause are potential candidates for further preoperative evaluation. Patients with decreased respiratory responses to hypoxia/hypercapnia stimuli and a high arousal threshold presenting with recurrent severe hypoxemia may benefit from preoperative CPAP.