Sleep apnea, particularly obstructive sleep apnea (OSA), significantly increases perioperative anesthesia risk due to recurrent airway obstruction, oxygen desaturation, and sensitivity to sedatives and opioids. Many patients with OSA remain undiagnosed, making perioperative identification and risk management essential components of anesthesia care. OSA affects breathing during sleep and sedation, increasing the likelihood of respiratory complications during and after anesthesia.

Patients with OSA are at higher risk of difficult airway management due to anatomical features such as large tongue size, thick neck circumference, and reduced airway tone. During anesthesia induction and sedation, loss of muscle tone can result in airway collapse, leading to hypoxia and ventilation difficulty. These risks are amplified in obese patients and those undergoing procedures requiring deep sedation or general anesthesia.

Perioperative assessment focuses on identifying known or suspected OSA through medical history, screening tools, and evaluation of symptoms such as loud snoring, daytime sleepiness, and witnessed apneas. Patients using continuous positive airway pressure (CPAP) therapy are advised to continue treatment and bring their devices for postoperative use when appropriate.

Anesthetic management in OSA patients emphasizes airway safety, careful drug selection, and vigilant monitoring. Sedatives and opioids are minimized due to increased sensitivity and risk of respiratory depression. Regional anesthesia techniques are preferred when feasible, as they reduce airway and respiratory compromise.

Postoperative risk is particularly high in OSA patients, as residual anesthetic effects, pain medications, and supine positioning can worsen airway obstruction. Close monitoring in the recovery area, extended observation, and use of CPAP therapy help prevent complications such as hypoventilation, hypoxia, and cardiac events.

Effective perioperative management of OSA reduces unplanned admissions, respiratory complications, and length of hospital stay. Through early identification and tailored anesthesia strategies, anesthesiology teams ensure safer surgical outcomes for patients with sleep-disordered breathing.