Original Article| Volume 27, ISSUE 5, P316-322, October 2012

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An Evidence-Based Checklist for the Postoperative Management of Obstructive Sleep Apnea

Published:August 13, 2012DOI:
      Obstructive sleep apnea (OSA) can present significant challenges in providing postoperative care. OSA policies have been developed and are in place within many facilities; however, a standard OSA protocol ensuring the safe delivery of postoperative care has not been universally accepted into practice. A synthesis of current OSA literature led to the development of a comprehensive evidence-based checklist to improve patient safety and direct the management of postoperative care for diagnosed or suspected OSA patients throughout their hospitalization. The checklist describes interventions for providing care in the immediate postoperative phase and sleep-specific interventions. These interventions include guidelines for postoperative assessment, continuous monitoring, extubation readiness, pain management, sleep positioning, respiratory monitoring, and continuous positive airway pressure therapy. The implementation of this checklist with the synergistic effect of the combined interventions may lead to a greater improvement in the care, safety, satisfaction, and clinical outcomes of OSA patients.


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        • Baluch A.
        • Mahbubani S.
        • Al-Fadhli F.
        • Kaye A.
        • Frost E.A.
        Anesthetic care of the patient with obstructive sleep apnea.
        Middle East J Anesthesiol. 2009; 20: 143-152
        • Rudra A.
        • Chatterjee S.
        • Das T.
        • Sengupta S.
        • Maitra G.
        • Kumar P.
        Obstructive sleep apnea and anesthesia.
        Indian J Crit Care Med. 2008; 12: 116-123
        • Richard R.
        • Morgenthaler T.
        • Lickteig C.
        • Carr C.
        RTs' role in the perioperative management of OSA.
        RT. 2007; 20: 20-22
        • Gross J.
        • Bachenberg K.
        • Benumof J.
        • et al.
        Practice guidelines for the perioperative management of patients with obstructive sleep apnea: A report by the American Society of Anesthesiologists Task Force on Perioperative Management of obstructive sleep apnea.
        Anesthesiology. 2006; 104: 1081-1093
      1. Ogan O, Plevak D. Anesthesia safety always an issue with obstructive sleep apnea. Available at: Accessed June 23, 2011.

        • Gay P.
        Sleep and sleep-disordered breathing in the hospitalized patient.
        Respir Care. 2010; 55: 1240-1254
        • Roop K.
        What are the post-op risks in patients who have obstructive sleep apnea? To what extent are patients with obstructive sleep apnea syndrome (OSAS) at increased risk for postoperative complications? Are there any specific interventions that reduce the risks?.
        J Respir Dis. 2008; 29: 389
        • Sheldon A.
        • Belan I.
        • Neill J.
        • Rowland S.
        Nursing assessment of obstructive sleep apnea in hospitalised adults: A review of risk factors and screening tools.
        Contemp Nurse. 2009; 34: 19-33
        • Isono S.
        Obstructive sleep apnea of obese adults: Pathophysiology and perioperative airway management.
        Anesthesiology. 2009; 110: 908-921
        • Abrishami A.
        • Khajehdehi A.
        • Chung F.
        A systematic review of screening questionnaires for obstructive sleep apnea.
        Can J Anaesth. 2010; 57: 423-438
      2. Mayo Clinic. Obstructive Sleep Apnea. Available at: Accessed June 23, 2011.

        • Netzer N.
        • Stoohs R.
        • Netzer C.
        • Clark K.
        • Strohl K.
        Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome.
        Ann Intern Med. 1999; 131: 485-491
        • Chung F.
        • Yegneswaran B.
        • Laio P.
        • et al.
        STOP questionnaire: A tool to screen patients for obstructive sleep apnea.
        Anesthesiology. 2008; 108: 812-821
        • Benumof J.
        Obstructive sleep apnea in the adult obese patient: Implications for airway management.
        Anesthesiol Clin North America. 2002; 20: 789-811
        • McCarter T.
        • Shaik Z.
        • Scarfo K.
        • Thompson L.
        Capnography monitoring enhances safety of postoperative patient-controlled analgesia.
        Am Health Drug Benefits. 2008; 1: 28-35
        • Blake D.
        • Yew C.
        • Donnan G.
        • Williams D.
        Postoperative analgesia and respiratory events in patients with symptoms of obstructive sleep apnoea.
        Anaesth Intensive Care. 2009; 37: 720-725
        • Walsh S.
        • Berry K.
        Electroacupuncture and TENS: Putting theory into practice.
        Am J Chin Med. 2010; 92: 46-58
        • Kasuya Y.
        • Akca O.
        • Sessler D.
        • Ozaki M.
        • Komatsu R.
        Accuracy of postoperative end-tidal PCO2 measurements with mainstream and sidestream capnography in non-obese patients and in obese patients with and without obstructive sleep apnea.
        Anesthesiology. 2009; 111: 609-615
        • Hutchison R.
        • Rodriguez L.
        Capnography and respiratory depression: Is capnography a good way to monitor at-risk postsurgical patients? A prospective trial examines the question.
        Am J Nurs. 2008; 108: 35-39
        • Ballard R.
        Management of patients with obstructive sleep apnea.
        J Fam Pract. 2008; 57: S24
      3. Volpe K. ASA Apnea Guidelines fill gap, leave holes. 2008;34. Available at: Accessed June 23, 2011.

        • Chung F.
        • Subramanyam R.
        • Liao P.
        • Sasaki E.
        • Shapiro C.
        • Sun Y.
        High STOP-Bang score indicates a high probability of obstructive sleep apnoea.
        Br J Anaesth. 2012; 108: 768-775


      Brian T. Gammon, RN, BSN, CCRN, is a Staff Nurse at Duke University Hospital, and Karen F. Ricker, RRT, MSN, CRNA is Associate Clinical Faculty at Duke School of Nursing, Davis Ambulatory Surgical Center & Durham Regional Hospital.