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American Medicine

In the United States, there is an epidemic of obstructive sleep apnea (also called sleep apnea or OSA).  OSA is common in the United States.  25% of men and 10% of women have sleep apnea.  This is important because it is complicated by an increased rate of death from abnormal heart rhythms, as well as low oxygen levels that can produce cardiac and brain side effects.  Also, importantly, patients who have sleep apnea have fatigue and daytime sleepiness because they do not get sufficient sleep at night, and their quality of life is impaired.

Another complication is being observed.  Many patients are going to surgery and have unsuspected and undiagnosed sleep apnea.  In fact, sleep apnea remains undiagnosed in about 80% of patients who are going to surgery.  This is associated with an increased risk of side effects from surgery including pulmonary and cardiac complications which can prolong hospitalizations and even cause death.

For patients undergoing elective surgery, according S. Mentsoudis and colleagues (reported in the New England Journal of Medicine 2013; 368:2352), 25% of all patients undergoing elective surgery had sleep apnea.  This is important because after operations such patients should have treatment with PAP (positive airway pressure) to reduce the risk of complications.  It is also suggested that such patients might be observed for longer time before discharge in order to reduce the risk of respiratory failure.  Some patients might even have to be admitted over night, but knowing that a patient has sleep apnea before they go to surgery is important.

In the United States, we are very familiar with getting a clearance from the internist or the cardiologist before a patient goes to surgery in order to minimize the complications from coronary artery disease, diabetes or emphysema.  However, many physicians have not evaluated patients for sleep apnea, which is increasing the risk of unexpected side effects for the operation.

So here are my tips for today:

• Ask your physician if it is possible that you can have sleep apnea.  This is especially important if you have daytime sleepiness or periods of awakening at night.
• If you snore at night, are obese, or have high blood pressure (even if it is under control with medicine) be certain to ask your physician to evaluate you for sleep apnea.
• If you have sleep apnea, make certain that the surgeon and anesthesiologist know about it before you have an operation.
• If you are going to have an operation, be certain that you ask the anesthesiologist if you have any symptoms of sleep apnea and if a sleep test should be performed prior to surgery.
• Specifically ask the surgeon and anesthesiologist if you should have PAP after the operation in the recovery room.

Getting enough sleep time in critically important to your health.

For more information, see my new book “Surviving American Medicine.”