Safe Surgery and Sleep Apnea Information

Sleep apnea is a condition in which breathing pauses or becomes shallow during sleep. Most people with the condition are not aware that they have it.

It is important for your health care providers to know whether or not you have sleep apnea, especially if you are having surgery. Sleep apnea can increase your risk of complications during and after surgery.

What is sleep apnea screening?

Sleep apnea screening is a test to determine if you are at risk for sleep apnea. Before you have surgery, get screened for sleep apnea and talk with your surgeon and primary health care provider about your results. Screening usually involves answering a list of questions about your sleep quality. Ask your health care provider if you can be screened, or take a screening test yourself. You can find these tests online at the American Sleep Apnea Association website. Some questions you may be asked include:

• Do you snore?
• Is your sleep restless?
• Do you have daytime sleepiness?
• Has a partner or spouse told you that you stop breathing during sleep?
• Have you had trouble concentrating or memory loss?

Answer these questions honestly. If a screening test is positive, this means you are at risk for the condition. Further testing may be needed to confirm a diagnosis of sleep apnea.

Why does sleep apnea increase the risk for complications?

Untreated sleep apnea increases the risk for certain complications during and after surgery. This is because when you have sleep apnea, your airways are more sensitive to medicines used during surgery. The airways can collapse and block the flow of air.

Having untreated sleep apnea can increase your risk for:

• A longer stay in the recovery room or hospital.
• Breathing difficulties such as low oxygen levels after surgery.
• Increased pain after surgery.
• Irregular heart rhythms.
• Stroke.
• Heart attack.

You and your health care provider can take steps to help prevent these and other complications.

What should I do if I have sleep apnea?

Before surgery

• Tell your health care provider and anesthesia specialist that you have sleep apnea. Discuss your individual risks based on your screening results, the type of surgery you will be having, and other medical conditions that you have.
• If you have a sleep apnea device (positive airway pressure device), wear it as prescribed. If you have not been wearing your device, talk with your health care provider about why you have not been wearing it. There are ways to improve your use of the device, such as:
  • Adjusting the mask.
  • Adding humidified air.
  • Getting treatment for nasal congestion.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.

On the day of surgery

• If instructed by your health care provider, bring your sleep apnea device with you.
• Wear your sleep apnea device when you are sleeping during your hospital stay, or as told by your health care provider.
• Ask your health care provider what special considerations will be taken during and after your surgery.

After surgery

• You may need to be given extra oxygen and wear a continuous oxygen monitor (pulse oximetry).
• For your safety, you may need to stay in the recovery room or hospital for longer than is normal.
• Follow instructions from your health care provider about wearing your sleep device:
  • Anytime you are sleeping, including during daytime naps.
  • While taking prescription pain medicines, sleeping medicines, or medicines that make you drowsy.
• If your health care provider approves, raise the head of your bed or lie on your side. Do not lie flat on your back.
• Follow instructions from your health care provider about medicines:
  • Avoid using sleep medicines unless they are prescribed by a health care provider who is aware of the results of your sleep apnea screening.
  • Avoid using sleep medicines while taking opioid pain medicine.
  • Limit your use of opioid pain medicines as much as possible. Ask your health care provider what is a safe amount to use.
  • Ask about using pain medicines that do not affect your breathing, such as NSAIDs or acetaminophen.

Where to find more information

For more information about sleep apnea screening and healthy sleep, visit these websites:

• Centers for Disease Control and Prevention: www.cdc.gov/sleep/index.html  
• American Sleep Apnea Association: www.sleepapnea.org  

Contact a health care provider if:

• You have sleep apnea or think you may be at risk for sleep apnea, and you are scheduled for surgery.

Get help right away if:

• You have trouble breathing.
• You are very drowsy and cannot stay awake.
• You are told that you have pauses in your breathing during sleep after surgery.
• You have chest pain.
• You have a fast heartbeat.

Summary

• It is important for your health care providers to know whether or not you have sleep apnea, especially if you are having surgery.
• If you have sleep apnea, you are at an increased risk for complications during surgery.
• You and your health care provider can take precautions to help prevent complications. If you have sleep apnea, make sure to tell your health care provider and anesthesia specialist.