Large, retrospective clinical cohorts suggest that preoperative diagnosis of obstructive sleep apnea (OSA) is associated with more than a two-fold increase in the risk for respiratory complications in the immediate postoperative period (i.e., the first 12 hours after surgery).1-6 The contribution of OSA to the causal nature of these complications remains unclear; however, an increased vulnerability of OSA patients to anesthesia- and opioid-induced ventilatory compromise has been proposed as a likely mechanism.7,8
This hypothesis is supported by experimental and clinical evidence suggesting that chronic intermittent hypoxia, a hallmark phenotype of OSA, may enhance the sensitivity to the analgesic and respiratory-depressant effects of opioids.9-15 Furthermore, retrospective analyses of life-threatening opioid-related respiratory events in the context of postoperative analgesia have shown that obesity, somnolence and OSA diagnosis were common among afflicted patients.6,7,16,17 Although hypoxemia due to...
