Pre-operative screening for sleep disordered breathing: obstructive sleep apnoea and beyond

Sleep disordered breathing describes an important group of conditions that causes abnormal nocturnal gas exchange, with important implications in the peri-operative management plan. An understanding of the pathophysiology behind obstructive sleep apnoea and other disorders that may lead to hypoventilation can help to prevent complications. Patients with these disorders may be minimally symptomatic and it requires careful screening in the pre-operative assessment process for a diagnosis to be made. Decisions regarding initiation of therapy, such as positive airway pressure, and delay of the operation need to be carefully weighed up against the urgency of the surgical intervention. Planning of the peri-operative care, including the use of positive airway pressure therapy and appropriate post-operative monitoring, can help to avoid respiratory and cardiovascular morbidities and improve clinical outcomes. EDUCATIONAL AIMS: To review different types of sleep disordered breathing and available screening methods in pre-operative assessment. To understand the pathophysiology behind sleep disordered breathing and how it can lead to complications in the peri-operative setting. To review the planning and treatment strategies that should be considered as part of peri-operative management.