According to the Centers for Disease Control and Prevention, the rate of Americans with obesity has continued to increase over the past decade. There is an indisputable correlation between obesity and sleep apnea, so as our nation continues to grow fatter, the prevalence of sleep apnea also increases. While much of today’s sleep apnea research focuses on its symptoms, treatment, and serious comorbidities, there is less research available on sleep apnea and anesthesia. Regardless of your age, gender, or BMI, if you are having surgery or a procedure and “going under,” whether with conscious sedation or general anesthesia, you will likely be asked preoperatively if you have sleep apnea.

Sleep apnea affects over 25 million people in the US alone, but perhaps its greatest danger is that up to 80% of those who have it go undiagnosed. The most common symptoms of sleep apnea include snoring or gasping during sleep, morning headaches, daytime sleepiness, difficulty focusing or feeling “fuzzy,” and overall fatigue. Because sleep apnea also has severe comorbidities such as high blood pressure, diabetes, and heart disease, it is vital to get screened and start treatment. To understand the sleep apnea/anesthesia relationship, it is helpful to understand what occurs during a sleep apnea event.

For those who suffer from sleep apnea, the tongue and muscles in the throat relax and collapse during sleep, resulting in obstructed airflow to the lungs. If the patient is obese, a large neck may contribute to the narrowing of the breathing tube and blockage of the airway. Lapses in breathing lasting typically between 10 to 20 seconds repeatedly occur throughout the night. When breathing stops, oxygen levels in the blood drop. Our bodies respond by releasing the stress hormone epinephrine, more commonly known as adrenaline. This “fight or flight” response elevates the heart rate and can lead to high blood pressure and a decrease in heart function. It is no wonder that screening for sleep apnea has become a standard procedure before sedation or general anesthesia.

According to the California Society of Anesthesiology, anesthesia medications and gases can temporarily decrease the heart’s pumping ability and affect blood flow to the organs. For those with serious health issues, anesthesia can put stress on the body. For many undergoing general anesthesia, a tube may be put down the throat and a ventilator may be used to assist with breathing. Knowing that anesthesia requires monitored breathing assistance while a patient is unconscious and that sleep apnea involves lapses in breathing during sleep, one could assume that the two could never happen simultaneously and that sleep apnea patients should not undergo anesthesia.

Anesthesia can be riskier for patients with sleep apnea because anesthesia slows down breathing and can make you more sensitive to its effects. It can also be more difficult to “come out” of the sedation, so monitoring by an anesthesiologist must continue postoperatively as well. The American Society of Anesthesiologists suggests that anyone who thinks they may suffer from sleep apnea discuss their surgery with their doctor to ensure that their care plan includes monitoring before, during, and after the surgery by a physician anesthesiologist. The medications used and the enhanced level of monitoring will be determined by the severity of the sleep apnea and if there are any comorbidities.

It is essential to proactively take care of our health because you never know when a medical emergency will arise. Screening for sleep apnea and starting treatment if there is a positive diagnosis is important to be at your best if surgery or a medical procedure will require sedation or general anesthesia. Sleep health is critical to overall health. Being an informed patient in partnership with your doctors will always lead to the best patient outcomes.

To learn more about how BetterNight can help you provide more effective and efficient care to at-risk sleep apnea patients, contact us.