Perioperative Management of Patients with Obstructive Sleep Apnea: A Narrative Review

Abstract

This narrative review aimed to examine current evidence on the perioperative management of patients with OSA, focusing on preoperative screening and risk assessment, airway and anesthetic management, analgesic strategies, postoperative respiratory care, positive airway pressure (PAP) therapy, and perioperative complications. Literature searches were conducted through PubMed/MEDLINE and Google Scholar using combinations of terms related to obstructive sleep apnea, perioperative management, preoperative screening, anesthesia, airway management, analgesia, postoperative respiratory complications, PAP therapy, and ambulatory surgery. Original studies, observational studies, systematic reviews, meta-analyses, clinical guidelines, and relevant narrative reviews were considered, with greater emphasis on publications from 2023 to 2026. The reviewed evidence indicated that preoperative identification of OSA, assessment of disease severity, airway characteristics, comorbidities, and surgical risk are important for perioperative planning. OSA was associated with increased respiratory adverse events and airway interventions during procedural sedation and higher odds of same-day hospital admission following ambulatory surgery. Regional or neuraxial anesthesia, opioid-sparing analgesia, neuromuscular blockade monitoring, postoperative respiratory surveillance, and appropriate use of PAP therapy were identified as important components of perioperative care. Overall, perioperative management should be individualized according to OSA characteristics, surgical procedure, anesthetic technique, opioid requirements, and postoperative monitoring needs.