ICU May Not Be Necessary After Sleep Apnea Surgery

MONDAY March 19, 2012 -- After undergoing surgery for obstructive sleep apnea, patients require close monitoring but may not need to be in an intensive care unit, according to a new study.

Obstructive sleep apnea is a disorder in which a person experiences abnormal pauses in breathing while they sleep. Sleep apnea can put people at risk of high blood pressure, stroke and heart problems.

Treatments include losing weight and continuous positive airway pressure (CPAP) devices, although some people may need surgery.

The surgery itself carries risks, however, the experts note. These include post-operative breathing difficulties, so patients are often placed in ICUs afterward.

But is that always necessary? To find out, researchers at the Pacific Sleep Centre in Singapore reviewed the cases of nearly 500 sleep apnea patients who had surgery between early 2007 and mid-2010. The surgeries included nasal, palate and tongue procedures.

The overall complication rate was 7 percent, according to the study, which appears online March 19 in the Archives of Otolaryngology -- Head & Neck Surgery.

Patients who undergo surgery for sleep apnea will end up with small lower jaws, making airway access difficult for anesthesiologists, the researchers noted. Another risk is dangerously slowed breathing due to anesthetics such as muscle relaxants and narcotics.

While routine admission to the ICU may not be necessary for all patients who've just had sleep apnea surgery, all patients should be closely monitored in the recovery or high-dependency area (one step below intensive care) for at least 3 hours after surgery, the researchers suggested.

"In conclusion, we strongly recommended that the clinician manage the patient with OSA [obstructive sleep apnea] with caution and prudence, with the understanding that these patients have a higher risk of airway compromise and respiratory depression intraoperatively and postoperatively," they wrote.

Dr. Lisa Liberatore, an ear, nose and throat specialist at Lenox Hill Hospital in New York City, said sleep apnea patients often have other medical issues that may raise surgical risks.

Because of the risks, surgeons should proceed with caution and patients should first try other, non-surgical treatments, she said.

"I recommend that the patient use CPAP first and lose at least 20 to 30 pounds before doing any surgery," Liberatore said.

More information

The U.S. National Heart, Lung, and Blood Institute has more about sleep apnea treatment.

Posted: March 2012


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