Did you take the quiz on STOPBANG?
or the 10 likely signs you have sleep apnea?
Are you already on CPAP?
Do you snore?
Is your BMI over 35?
Do you have a thick neck?
If you screened positive for any sleep apnea issues, there are things we can do to optimize you around the time of surgery where you require a General Anesthetic (you go fully to sleep) and you need opioid pain medications (which sedate you, and decrease your drive to breathe).
Sleep apnea has been shown to be associated with pulmonary hypertension in 12-34% of patients. It is an independent risk factor for high blood pressure, stroke, myocardial ischemia (not enough blood flow to the heart which puts you at risk for a heart attack), congestive heart failure, arrhythmias and sudden cardiac death.
If a minor surgery, and you are not taking much more than a low dose of opioid after surgery, you can likely go home.
Signs you might need an overnight stay in a hospital:
- recurrent respiratory events
- new CPAP therapy
- respiratory failure
- significant risk of heart attack or arrythmia
- pain sedation mismatch
- If you have a prolonged stay in the Post-op Recovery Unit, you may need further observation if your oxygenation level is below 90%, your respiratory rate is less than 8 breaths/minute, you have apneic episodes of longer than 10 seconds, or you have a pain-sedation mismatch.
In the hospital they can put you on a continuous pulse oximetry, which is a little clip they put on your finger which lets us know your oxygen saturation in your blood, and give you oxygen. Studies have shown 80% of events happened in the first 24 hours after surgery if there was to be an event.
TAKE HOME MESSAGE:
Sleep is important. Around the time of surgery, many medications used make you sleepy and depress your drive to breathe. If you already have issues with your breathing while sleeping, you should know what those are before surgery, and take measures to
1. stratify your risk (how bad is your apnea? have you done a sleep study? As apnea is associated with heart and lung issues, have a good preoperative evaluation of those as well)
2. improve your risk (wait to do surgery until you lose weight, are on CPAP for a while, do a smaller surgery under local anesthesia if possible, etc) or
3. do your surgery in a major center where you can stay overnight if required.