Demographics and diagnosis of obstructive sleep apnea

OSA is a prevalent and often undiagnosed condition in the general population. There are several underlying reasons for the disparity between the prevalence of OSA and the current level of clinical recognition. The standard diagnostic test (polysomnogram) is labor intensive, time consuming, and available primarily through centers that specialize in sleep medicine. This limitation in the diagnostic infrastructure coupled with the fact that most physicians fail to recognize sleep-related symptoms has limited the number of individuals that have been appropriately identified. The lack of recognition of patients with undiagnosed OSA presents a dilemma for the anesthesia care provider. When the diagnosis of OSA is known, traditional provisions for management have included a specific plan and the equipment to secure the difficult airway and the ability to monitor the patient postoperatively, with increased surveillance for obstructive apneic episodes. These additional resources can be arranged, and the surgical procedure can be scheduled in an appropriate location of care to ensure the safety of the patient. Although screening for OSA is commonly performed in the preoperative setting, standardized methods for identifying affected but undiagnosed individuals are lacking. The availability of a simple and valid screening method that identifies individuals with undiagnosed OSA is of paramount significance to streamline the perioperative management of such patients and deter adverse postoperative sequelae.