Book contents
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Introduction
- Part 1 Perioperative Care of the Surgical Patient
- Part 2 Surgical Procedures and their Complications
- Section 17 General Surgery
- Section 18 Cardiothoracic Surgery
- Section 19 Vascular Surgery
- Section 20 Plastic and Reconstructive Surgery
- Section 21 Gynecologic Surgery
- Section 22 Neurologic Surgery
- Section 23 Ophthalmic Surgery
- Section 24 Orthopedic Surgery
- Section 25 Otolaryngologic Surgery
- Chapter 127 Otologic surgery
- Chapter 128 Tympanotomy tubes
- Chapter 129 Tonsillectomy and adenoidectomy
- Chapter 130 Surgery for obstructive sleep apnea
- Chapter 131 Endoscopic sinus surgery: indications, prognosis, and surgical complications
- Chapter 132 Aesthetic facial plastic surgery
- Chapter 133 Surgical treatment of head and neck cancer
- Chapter 134 Reconstruction after cancer ablation
- Chapter 135 Surgical management of thyroid malignancies
- Chapter 136 Anterior cranial base surgery
- Chapter 137 Acute airway emergencies
- Section 26 Urologic Surgery
- Index
- References
Chapter 130 - Surgery for obstructive sleep apnea
from Section 25 - Otolaryngologic Surgery
Published online by Cambridge University Press: 05 September 2013
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Introduction
- Part 1 Perioperative Care of the Surgical Patient
- Part 2 Surgical Procedures and their Complications
- Section 17 General Surgery
- Section 18 Cardiothoracic Surgery
- Section 19 Vascular Surgery
- Section 20 Plastic and Reconstructive Surgery
- Section 21 Gynecologic Surgery
- Section 22 Neurologic Surgery
- Section 23 Ophthalmic Surgery
- Section 24 Orthopedic Surgery
- Section 25 Otolaryngologic Surgery
- Chapter 127 Otologic surgery
- Chapter 128 Tympanotomy tubes
- Chapter 129 Tonsillectomy and adenoidectomy
- Chapter 130 Surgery for obstructive sleep apnea
- Chapter 131 Endoscopic sinus surgery: indications, prognosis, and surgical complications
- Chapter 132 Aesthetic facial plastic surgery
- Chapter 133 Surgical treatment of head and neck cancer
- Chapter 134 Reconstruction after cancer ablation
- Chapter 135 Surgical management of thyroid malignancies
- Chapter 136 Anterior cranial base surgery
- Chapter 137 Acute airway emergencies
- Section 26 Urologic Surgery
- Index
- References
Summary
Obstructive sleep apnea (OSA) is a serious and chronic condition affecting as many as 15–20 million American adults. Resulting sleep deprivation has been linked to motor vehicle and workplace accidents. The incidence of OSA is increasing with the obesity epidemic, and it is increasingly recognized as a mediator of cardiovascular disease including atrial fibrillation, stroke, myocardial infarction, and sudden cardiac death. The importance of appropriate diagnosis and timely treatment thus cannot be overstated.
Obstructive sleep apnea manifests by repeated episodes of apnea or hypopnea during sleep. During deeper levels of sleep, especially that characterized by rapid eye movement (REM), there is loss of the normal tone of the pharyngeal and tongue muscles that keep the pharynx open, resulting in collapse of the oropharyngeal and nasopharyngeal airway. In the majority of the population this decrease in airway diameter is clinically insignificant. However, in OSA patients the varied degree of airway obstruction can have clinical consequences. Narrowing of the airway causes increased velocity of inspiratory airflow in the pharynx, causing decreased intraluminal pressure, further tissue collapse, and increased airway obstruction (Bernoulli's principle). In instances of complete airway obstruction, the patient will experience apnea, a cessation of breathing for at least 10 seconds. Incomplete obstruction may result in hypopnea, a reduction in airflow with associated oxygen desaturation, which is more common. Each apnea or hypopnea episode continues until the patient awakens to a more shallow level of sleep, which results in a recovery of pharyngeal muscle tone and recovery of airway integrity. The more frequent the apnea and hypopnea, the more fragmented the sleep, which results in greater sleep deprivation due to the lack of adequate REM activity.
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- Medical Management of the Surgical PatientA Textbook of Perioperative Medicine, pp. 761 - 763Publisher: Cambridge University PressPrint publication year: 2013