Sleep apnea syndrome in patients undergoing total joint arthroplasty

Sleep apnea syndrome (SAS) is a condition of repeated episodes of apnea and hypopnea during sleep. It can cause life-threatening morbidities, including cardiac arrhythmia and ischemia, hypertension, and respiratory arrest, and even death. In a retrospective study at our institution of patients who underwent hip or knee total joint arthroplasty (TJA) with a diagnosis of SAS, we hypothesized that avoiding factors that exacerbate SAS in the perioperative period would minimize adverse outcomes. There were 19 patients with a preoperative diagnosis of moderate or severe SAS; 15 patients received continuous positive airway pressure or bilevel positive airway pressure noninvasive ventilation, 1 patient experienced respiratory arrest secondary to intraoperative propafol, and 2 patients developed postoperative respiratory depression. Avoidance of opioids and sedative drugs, awareness of the possibility of acute airway obstruction, and close monitoring during and after surgery are vital in patients with SAS.