Why Apnea Is a Surgical Risk—and What to Do About It

U.S. News asked Frances Chung, a professor at the University of Toronto's University Health Network, about the surgery-associated risks tied to sleep apnea. Chung was the lead author of a new study that offers a tool to help diagnose sleep apnea. Excerpts:

What is it about sleep apnea that poses a problem during surgery?
There are two components to it. Obstructive sleep apnea in general is an issue for a lot of patients, and it is underdiagnosed. And these patients are more difficult to manage in terms of anesthesia. It may be the morphine afterwards for some of them. These patients are much more sensitive to pain medications.

Do doctors, clinics, and hospitals usually screen patients for sleep apnea prior to surgery?
It's not a routine. That's why what we are doing is important. That is why we actually came up with this STOP tool. People are aware that there is an issue and there is a need, and we've come up with a simple tool which anybody can use.

Do complications typically occur during or after surgery?
Complications are less likely during the surgery itself because the anesthesiologist is there, and we make sure the patient is breathing OK. Most of the risk for surgery is actually afterwards. During surgery, we are with the patient, so if anything happens, we are there to treat them. But afterwards patients are by themselves, with nurses and doctors checking on them but not there constantly.

What can be done to reduce the risk of complications?
If you know you have sleep apnea, most of the time you would've seen a sleep specialist, who would recommend treatment. If it's very mild sleep apnea, you probably don't need treatment. But those with more severe sleep apnea need CPAP [continuous positive airway pressure] treatment. These patients usually wear a CPAP machine while sleeping. It expands the airway so that when you sleep, your airway doesn't get obstructed.

So if you're coming for surgery and you have mild sleep apnea, you probably don't have anything to worry about. But if you have a CPAP machine, the anesthesiologist will usually put you back on the CPAP machine after surgery. And we take additional precautions after surgery.

Is it ever unsafe to have surgery if you have sleep apnea, perhaps if you're planning cosmetic surgery or another elective procedure?
I think the risk is really low. What we are saying is that we should screen for sleep apnea, and then we'll take the proper precautions.