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Laryngorhinootologie 2015; 94(08): 516-523
DOI: 10.1055/s-0035-1549926
Positionspapier
© Georg Thieme Verlag KG Stuttgart · New York

Positionspapier zum perioperativen Management von erwachsenen Patienten mit obstruktiver Schlafapnoe bei HNO-ärztlichen Eingriffen

Position Paper: Perioperative Management of Adult Patients with Obstructive Sleep Apnea in ENT Surgery
M. Rösslein
1   Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Freiburg
,
H. Bürkle
1   Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Freiburg
,
A. Walther
2   Klinik für Anästhesiologie und operative Intensivmedizin, Katharinenhospital, Klinikum Stuttgart
,
B. A. Stuck
3   Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Essen
,
T. Verse
4   Abteilung für HNO-Heilkunde, Kopf- und Halschirurgie, Asklepios Klinikum Harburg
› Author Affiliations
Further Information

Publication History

Publication Date:
04 August 2015 (online)

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Zusammenfassung

Die obstruktive Schlafapnoe (OSA) ist eine im Schlaf auftretende Atmungsstörung mit zunehmender Prävalenz, bei der es trotz fortbestehender Atemanstrengung zu einer sich wiederholenden, teilweisen oder vollständigen Verlegung des pharyngealen Atemweges kommt. In Abhängigkeit vom Schweregrad der Erkrankung kann dies zu Schlafunterbrechungen, einer Gasaustauschstörung sowie kardiovaskulären und metabolischen Folgeerkrankungen führen.

Chirurgische Patienten mit einer OSA, welche präoperativ in den meisten Fällen nicht diagnostiziert ist, haben ein erhöhtes Risiko für das perioperative Auftreten von pulmonalen, kardiovaskulären und weiteren Komplikationen.

Spezielle Maßnahmen können dazu beitragen, die Sicherheit der Patienten in dieser Phase zu erhöhen. Dazu zählen präoperativ die frühzeitige Erkennung und Einschätzung einer OSA und eventuell bestehender Begleiterkrankungen, intraoperativ die Auswahl eines geeigneten Anästhesie- und Überwachungsverfahrens sowie postoperativ die Aufrechterhaltung einer ausreichend langen Überwachungsdauer mit der Möglichkeit intensivmedizinischer Behandlungsmaßnahmen. Das konkrete Vorgehen sollte sich dabei nach dem individuellen Risikoprofil des einzelnen Patienten richten, das u. a. vom Schweregrad der OSA, der Invasivität des operativen Eingriffes und vom postoperativen Opioidbedarf sowie dem Auftreten kritischer Ereignisse in der frühen postoperativen Phase abhängt.

Auf Initiative und im Auftrag der Deutschen Gesellschaft für Hals-, Nasen-, Ohren-Heilkunde, Kopf- und Hals-Chirurgie sollen nachfolgend auf der Grundlage der bestehenden Literatur und bereits existierender Leitlinien anderer Fachgesellschaften Empfehlungen für das perioperative Management von erwachsenen Patienten mit OSA bei HNO-ärztlichen Eingriffen vorgestellt werden.

Schlüsselwörter

Obstruktive Schlafapnoe - perioperative Komplikationen - perioperatives Management

Key words

obstructive sleep apnea - perioperative complications - perioperative management
 

  • Literatur

  • 1 American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea . Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 2014; 120: 268-286
    CrossrefPubMedGoogle Scholar
  • 2 Joshi GP, Ankichetty SP, Gan TJ, Chung F. Society for Ambulatory Anesthesia consensus statement on preoperative selection of adult patients with obstructive sleep apnea scheduled for ambulatory surgery. Anesthesia and analgesia 2012; 115: 1060-1068
    CrossrefPubMedGoogle Scholar
  • 3 Seet E, Chung F. Management of sleep apnea in adults – functional algorithms for the perioperative period: Continuing Professional Development. Canadian journal of anaesthesia=Journal canadien d’anesthesie 2010; 57: 849-864
    PubMedGoogle Scholar
  • 4 American Academy of Sleep Medicine (ed.) International classification of sleep disorders. 3rd edn. American Academy of Sleep Medicine; Westchester, IL: 2014
    Google Scholar
  • 5 Heatley EM, Harris M, Battersby M, McEvoy RD, Chai-Coetzer CL, Antic NA. Obstructive sleep apnoea in adults: a common chronic condition in need of a comprehensive chronic condition management approach. Sleep medicine reviews 2013; 17: 349-355
    CrossrefPubMedGoogle Scholar
  • 6 Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G. Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. Journal of the American College of Cardiology 2013; 62: 569-576
    CrossrefPubMedGoogle Scholar
  • 7 Kezirian EJ, Maselli J, Vittinghoff E, Goldberg AN, Auerbach AD. Obstructive sleep apnea surgery practice patterns in the United States: 2000–2006. Otolaryngology – head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery 2010; 143: 441-447
    PubMedGoogle Scholar
  • 8 Lee W, Nagubadi S, Kryger MH, Mokhlesi B. Epidemiology of Obstructive Sleep Apnea: a Population-based Perspective. Expert review of respiratory medicine 2008; 2: 349-364
    CrossrefPubMedGoogle Scholar
  • 9 Yang YX, Spencer G, Schutte-Rodin S, Brensinger C, Metz DC. Gastroesophageal reflux and sleep events in obstructive sleep apnea. European journal of gastroenterology & hepatology 2013; DOI: 10.1097/MEG.0b013e32836282cf.
    PubMedGoogle Scholar
  • 10 Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 2008; 108: 822-830
    CrossrefPubMedGoogle Scholar
  • 11 Finkel KJ, Searleman AC, Tymkew H, Tanaka CY, Saager L, Safer-Zadeh E, Bottros M, Selvidge JA, Jacobsohn E, Pulley D, Duntley S, Becker C, Avidan MS. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep medicine 2009; 10: 753-758
    CrossrefPubMedGoogle Scholar
  • 12 Vasu TS, Grewal R, Doghramji K. Obstructive sleep apnea syndrome and perioperative complications: a systematic review of the literature. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 2012; 8: 199-207
    PubMedGoogle Scholar
  • 13 Ravesloot MJ, van Maanen JP, Hilgevoord AA, van Wagensveld BA, de Vries N. Obstructive sleep apnea is underrecognized and underdiagnosed in patients undergoing bariatric surgery. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology – Head and Neck Surgery 2012; 269: 1865-1871
    PubMedGoogle Scholar
  • 14 Gupta RM, Parvizi J, Hanssen AD, Gay PC. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study. Mayo Clinic proceedings Mayo Clinic 2001; 76: 897-905
    CrossrefPubMedGoogle Scholar
  • 15 Bahammam A, Delaive K, Ronald J, Manfreda J, Roos L, Kryger MH. Health care utilization in males with obstructive sleep apnea syndrome two years after diagnosis and treatment. Sleep 1999; 22: 740-747
    PubMedGoogle Scholar
  • 16 McNicholas WT, Ryan S. Obstructive sleep apnoea syndrome: translating science to clinical practice. Respirology (Carlton, Vic) 2006; 11: 136-144
    CrossrefPubMedGoogle Scholar
  • 17 Corso RM, Piraccini E, Calli M, Berger M, Gorini MC, Agnoletti V, Gambale G, Vicini C. Obstructive sleep apnea is a risk factor for difficult endotracheal intubation. Minerva anestesiologica 2011; 77: 99-100
    PubMedGoogle Scholar
  • 18 Kim JA, Lee JJ. Preoperative predictors of difficult intubation in patients with obstructive sleep apnea syndrome. Canadian journal of anaesthesia=Journal canadien d’anesthesie 2006; 53: 393-397
    PubMedGoogle Scholar
  • 19 Neligan PJ, Porter S, Max B, Malhotra G, Greenblatt EP, Ochroch EA. Obstructive sleep apnea is not a risk factor for difficult intubation in morbidly obese patients. Anesthesia and analgesia 2009; 109: 1182-1186
    CrossrefPubMedGoogle Scholar
  • 20 Siyam MA, Benhamou D. Difficult endotracheal intubation in patients with sleep apnea syndrome. Anesthesia and analgesia 2002; 95: 1098-1102 table of contents
    PubMedGoogle Scholar
  • 21 Chung F, Yegneswaran B, Herrera F, Shenderey A, Shapiro CM. Patients with difficult intubation may need referral to sleep clinics. Anesthesia and analgesia 2008; 107: 915-920
    CrossrefPubMedGoogle Scholar
  • 22 Stierer TL, Wright C, George A, Thompson RE, Wu CL, Collop N. Risk assessment of obstructive sleep apnea in a population of patients undergoing ambulatory surgery. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 2010; 6: 467-472
    PubMedGoogle Scholar
  • 23 Mayer G, Fietze I, Fischer J, Penzel Th, Riemann D, Rodenbeck A, Sitter H, Teschler H Hrsg 3-Leitlinie: Nicht erholsamer Schlaf/Schlafstörungen. Deutsche Gesellschaft für Schlafforschung und Schlafmedizin (DGSM) Somnologie 2009; 13: 4-160
    PubMedGoogle Scholar
  • 24 Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Canadian journal of anaesthesia=Journal canadien d’anesthesie 2010; 57: 423-438
    PubMedGoogle Scholar
  • 25 Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 2008; 108: 812-821
    CrossrefPubMedGoogle Scholar
  • 26 Ramachandran SK, Josephs LA. A meta-analysis of clinical screening tests for obstructive sleep apnea. Anesthesiology 2009; 110: 928-939
    CrossrefPubMedGoogle Scholar
  • 27 Chung F, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. British journal of anaesthesia 2012; 108: 768-775
    CrossrefPubMedGoogle Scholar
  • 28 Farney RJ, Walker BS, Farney RM, Snow GL, Walker JM. The STOP-Bang equivalent model and prediction of severity of obstructive sleep apnea: relation to polysomnographic measurements of the apnea/hypopnea index. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 2011; 7: 459B-465B
    PubMedGoogle Scholar
  • 29 Auckley D, Bolden N. Preoperative screening and perioperative care of the patient with sleep-disordered breathing. Current opinion in pulmonary medicine 2012; 18: 588-595
    CrossrefPubMedGoogle Scholar
  • 30 Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981; 1: 862-865
    PubMedGoogle Scholar
  • 31 Kaw R, Golish J, Ghamande S, Burgess R, Foldvary N, Walker E. Incremental risk of obstructive sleep apnea on cardiac surgical outcomes. The Journal of cardiovascular surgery 2006; 47: 683-689
    PubMedGoogle Scholar
  • 32 Kindgen-Milles D, Muller E, Buhl R, Bohner H, Ritter D, Sandmann W, Tarnow J. Nasal-continuous positive airway pressure reduces pulmonary morbidity and length of hospital stay following thoracoabdominal aortic surgery. Chest 2005; 128: 821-828
    CrossrefPubMedGoogle Scholar
  • 33 Liao P, Yegneswaran B, Vairavanathan S, Zilberman P, Chung F. Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study. Canadian journal of anaesthesia=Journal canadien d’anesthesie 2009; 56: 819-828
    PubMedGoogle Scholar
  • 34 Zarbock A, Mueller E, Netzer S, Gabriel A, Feindt P, Kindgen-Milles D. Prophylactic nasal continuous positive airway pressure following cardiac surgery protects from postoperative pulmonary complications: a prospective, randomized, controlled trial in 500 patients. Chest 2009; 135: 1252-1259
    CrossrefPubMedGoogle Scholar
  • 35 Ankichetty S, Wong J, Chung F. A systematic review of the effects of sedatives and anesthetics in patients with obstructive sleep apnea. Journal of anaesthesiology, clinical pharmacology 2011; 27: 447-458
    CrossrefPubMedGoogle Scholar
  • 36 Bachar G, Feinmesser R, Shpitzer T, Yaniv E, Nageris B, Eidelman L. Laryngeal and hypopharyngeal obstruction in sleep disordered breathing patients, evaluated by sleep endoscopy. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology – Head and Neck Surgery 2008; 265: 1397-1402
    PubMedGoogle Scholar
  • 37 Isono S, Remmers JE, Tanaka A, Sho Y, Sato J, Nishino T. Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects. Journal of applied physiology (Bethesda, Md: 1985) 1997; 82: 1319-1326
    PubMedGoogle Scholar
  • 38 Patil SP, Schneider H, Schwartz AR, Smith PL. Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest 2007; 132: 325-337
    CrossrefPubMedGoogle Scholar
  • 39 Sforza E, Petiau C, Weiss T, Thibault A, Krieger J. Pharyngeal critical pressure in patients with obstructive sleep apnea syndrome. Clinical implications. American journal of respiratory and critical care medicine 1999; 159: 149-157
    CrossrefPubMedGoogle Scholar
  • 40 Younes M. Contributions of upper airway mechanics and control mechanisms to severity of obstructive apnea. American journal of respiratory and critical care medicine 2003; 168: 645-658
    CrossrefPubMedGoogle Scholar
  • 41 Strauss SG, Lynn AM, Bratton SL, Nespeca MK. Ventilatory response to CO2 in children with obstructive sleep apnea from adenotonsillar hypertrophy. Anesthesia and analgesia 1999; 89: 328-332
    PubMedGoogle Scholar
  • 42 Waters KA, McBrien F, Stewart P, Hinder M, Wharton S. Effects of OSA, inhalational anesthesia, and fentanyl on the airway and ventilation of children. Journal of applied physiology (Bethesda, Md: 1985) 2002; 92: 1987-1994
    PubMedGoogle Scholar
  • 43 Adesanya AO, Lee W, Greilich NB, Joshi GP. Perioperative management of obstructive sleep apnea. Chest 2010; 138: 1489-1498
    CrossrefPubMedGoogle Scholar
  • 44 Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, Hagberg CA, Caplan RA, Benumof JL, Berry FA, Blitt CD, Bode RH, Cheney FW, Connis RT, Guidry OF, Nickinovich DG, Ovassapian A. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2013; 118: 251-270
    CrossrefPubMedGoogle Scholar
  • 45 Coussa M, Proietti S, Schnyder P, Frascarolo P, Suter M, Spahn DR, Magnusson L. Prevention of atelectasis formation during the induction of general anesthesia in morbidly obese patients. Anesthesia and analgesia 2004; 98: 1491-1495 table of contents
    PubMedGoogle Scholar
  • 46 Berry RB, Kouchi KG, Bower JL, Light RW. Effect of upper airway anesthesia on obstructive sleep apnea. American journal of respiratory and critical care medicine 1995; 151: 1857-1861
    CrossrefPubMedGoogle Scholar
  • 47 Deegan PC, Mulloy E, McNicholas WT. Topical oropharyngeal anesthesia in patients with obstructive sleep apnea. American journal of respiratory and critical care medicine 1995; 151: 1108-1112
    PubMedGoogle Scholar
  • 48 Liu SS, Wu CL. Effect of postoperative analgesia on major postoperative complications: a systematic update of the evidence. Anesthesia and analgesia 2007; 104: 689-702
    CrossrefPubMedGoogle Scholar
  • 49 Brown KA, Laferriere A, Lakheeram I, Moss IR. Recurrent hypoxemia in children is associated with increased analgesic sensitivity to opiates. Anesthesiology 2006; 105: 665-669
    CrossrefPubMedGoogle Scholar
  • 50 Brown KA, Laferriere A, Moss IR. Recurrent hypoxemia in young children with obstructive sleep apnea is associated with reduced opioid requirement for analgesia. Anesthesiology 2004; 100: 806-810 discussion 805A
    CrossrefPubMedGoogle Scholar
  • 51 Maund E, McDaid C, Rice S, Wright K, Jenkins B, Woolacott N. Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs for the reduction in morphine-related side-effects after major surgery: a systematic review. British journal of anaesthesia 2011; 106: 292-297
    CrossrefPubMedGoogle Scholar
  • 52 Kanagala R, Murali NS, Friedman PA, Ammash NM, Gersh BJ, Ballman KV, Shamsuzzaman AS, Somers VK. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 2003; 107: 2589-2594
    CrossrefPubMedGoogle Scholar
  • 53 Peled N, Abinader EG, Pillar G, Sharif D, Lavie P. Nocturnal ischemic events in patients with obstructive sleep apnea syndrome and ischemic heart disease: effects of continuous positive air pressure treatment. Journal of the American College of Cardiology 1999; 34: 1744-1749
    CrossrefPubMedGoogle Scholar
  • 54 El-Solh AA, Aquilina A, Pineda L, Dhanvantri V, Grant B, Bouquin P. Noninvasive ventilation for prevention of post-extubation respiratory failure in obese patients. The European respiratory journal 2006; 28: 588-595
    CrossrefPubMedGoogle Scholar
  • 55 Taenzer AH, Pyke JB, McGrath SP, Blike GT. Impact of pulse oximetry surveillance on rescue events and intensive care unit transfers: a before-and-after concurrence study. Anesthesiology 2010; 112: 282-287
    CrossrefPubMedGoogle Scholar
  • 56 Gali B, Whalen FX, Schroeder DR, Gay PC, Plevak DJ. Identification of patients at risk for postoperative respiratory complications using a preoperative obstructive sleep apnea screening tool and postanesthesia care assessment. Anesthesiology 2009; 110: 869-877
    CrossrefPubMedGoogle Scholar
  • 57 Kezirian EJ, Weaver EM, Yueh B, Khuri SF, Daley J, Henderson WG. Risk factors for serious complication after uvulopalatopharyngoplasty. Archives of otolaryngology – head & neck surgery 2006; 132: 1091-1098
    PubMedGoogle Scholar
  • 58 Kieff DA, Busaba NY. Same-day discharge for selected patients undergoing combined nasal and palatal surgery for obstructive sleep apnea. The Annals of otology, rhinology, and laryngology 2004; 113: 128-131
    PubMedGoogle Scholar
  • 59 Pang KP, Siow JK, Tseng P. Safety of multilevel surgery in obstructive sleep apnea: a review of 487 cases. Archives of otolaryngology – head & neck surgery 2012; 138: 353-357
    PubMedGoogle Scholar
  • 60 Regli A, von Ungern-Sternberg BS, Strobel WM, Pargger H, Welge-Luessen A, Reber A. The impact of postoperative nasal packing on sleep-disordered breathing and nocturnal oxygen saturation in patients with obstructive sleep apnea syndrome. Anesthesia and analgesia 2006; 102: 615-620
    CrossrefPubMedGoogle Scholar
  • 61 Rotenberg B, Hu A, Fuller J, Bureau Y, Arra I, Sen M. The early postoperative course of surgical sleep apnea patients. The Laryngoscope 2010; 120: 1063-1068
    PubMedGoogle Scholar
  • 62 Spiegel JH, Raval TH. Overnight hospital stay is not always necessary after uvulopalatopharyngoplasty. The Laryngoscope 2005; 115: 167-171
    CrossrefPubMedGoogle Scholar
  • 63 Terris DJ, Fincher EF, Hanasono MM, Fee Jr WE, Adachi K. Conservation of resources: indications for intensive care monitoring after upper airway surgery on patients with obstructive sleep apnea. The Laryngoscope 1998; 108: 784-788
    CrossrefPubMedGoogle Scholar