A presentation by Karl Franklin at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine. All available content from SSAI2017: https://scanfoam.org/ssai2017/ Delivered in collaboration between scanFOAM, SSAI & SFAI.

1. Best practices in the perioperative care of
obstructive sleep apnea
Ass Prof Karl Franklin MD,
Dept Surgery, Umeå, Sweden

3. 52 years, obese, snoring, taxi driver,
smokes, diabetes, daytime sleepiness

4. Sleep apnea covariates with early death, stroke, and
traffic accidents.
CPAP and mandibular repositioning appliances are
effective. No evidence for surgery, except for side-
effects.
Nordic HTA report, SBU 2007
Sleep 2009; 32: 27-36.

6. Mandibular Repositioning Appliances
MRA

9. Liao. Anesthesiology 2013
0
5
10
15
20
25
30
35
Control n=66 Auto PAP n=40
Preop AHI
Postop AHI
Apnea-hypopneaindexApnea-hypopneaindex
N.s. p<0.001
Randomized controlled trial

11. Mutter TC, Anesthesiology 2014
20488 Surgeries attended by anesthesiolgist, Canada
Post-op complications
0
1
2
3
CV compl Pulm compl
No OSA
n=16,277
Undiag OSA
n=1,571
CPAP treat OSA
n=2,640
p=0.009
N.s.

12. Untreated OSA on Cardio Pulmonary complications after
abdominal or vascular surgeries, US
00
02
04
06
08
10
Cardiopulmonary
complica on
Reintuba on Myocardial
infarc on
Non-OSA (24196)
Untreated OSA (1465)
CPAP treated OSA (1181)
p=0.003
p=0.031
p=0.001
Percent
Abdelsattar ZM et al. Sleep 2015

13. O´Gorman Chest 2013
0
2
4
6
8
10
12
Lenght of stay,
days
Complication,
numbers
Pulm Infiltrate or
atelectais, n
Controls n=43
Auto-CPAP n=43
Number
N.s.
N.s.
Randomized controlled trial, Orthopedic surgery

14. OSA patients on positive airway pressure (PAP)
should use it pre- and postoperative.
Evidence: Moderate, Recommendation: Strong
SASM guidelines Anesth Analg 2016:123:452

15. Sleep apnea patients not adherent or decline PAP
Proceed with surgery after discussion of pro and cons.
Evidence: Low, Recommendation: Weak
Improve compliance! -Consult a sleep apnea specialist
SASM guidelines Anesth Analg 2016:123:452

16. High probability of obstructive sleep apnea
Patient, surgeon, anesthesiologist informed on increased
post-op risks
Evidence: Low, Recommendation: Strong
Individual decision for further evaluation and treatment
Evidence: Low, Recommendation: Weak
SASM guidelines Anesth Analg 2016:123:452

17. Honolulu airport 19

18. What´s the problem about CPAP?

19. What´s the problem about CPAP?
Noisy
Complicated
Not sexy

20. Thank you
karl.franklin@umu.se

21. 0
10
20
30
40
50
60
Young
1993
Franklin
2013
Heinzer
2015
Young
1993
Heinzer
2015
Percent Moderate and severe OSA in the popula on
AHI >15
Women Men