Another coffee, another random thought ðŸ’🤓: We sleep almost a third of our lives away, so Sleep Apnea that unleashes damage while asleep can have huge impacts on health. These are slowly being uncovered, meanwhile innovations such as this Pacemaker-style device by Inspire Medical Systems, that opens up airways during inspiration are eliminating need for annoying CPAP masks.
Few years ago I witnessed an unfortunate incident in a gentleman who underwent a hip surgery for a post-fall fracture. In his late 50s without any other medical conditions besides obesity & hypertension, surgery went well. After surgery he was sleepy and hypoxic in PACU and then medical floor, but easy to awaken needing 2-3 liters oxygen – something seen often in post-op patients. A few hours later hypoxia was worse & he was difficult to arouse. A rapid respone was called. ABGs revealed a pH of 7.01 & a a pCO2 of 120 !! Soon after he had a tonic-clonic seizure from CO2 narcosis & ended up intubated in the ICU. Turns out he had undiagnosed sleep apnea that exacerbated respiratory depression after surgery from anesthesia, sedation & narcotics.
Post-op hypoxia & respiratory depression are common in people with sleep apnea. Conversely, if you observe hypoxia / respiratory depression in patients immediately post-op, there is a good chance of underlying sleep apnea. These issues are highlighted by articles and studies here, here & more recently here (2022). These patients carry two risks you should be mindful about: Hypoxic failure with CO2-retention narcosis AND excessive respiratory depressive response to Narcotics used for post-op pain control. And as if all this is not enough, recent research also shows impairement of cardiac blood flow in high-demand situations in severe sleep apnea.
💡 What can you medical providers do with this information ?
Screen for sleep apnea as a mandatory part of pre-operative evaluation using free calculators like STOP-BANG. The screen is not perfect, but a good start. If they screen negative, but have respiratory depression and hypoxia in post-op recovery, that should still alert you about possible undiagnosed sleep apnea. If they already have diagnosed sleep apnea, make sure their families bring in their CPAP machine to use post-op while drowsy, napping or sleeping. For undiagnosed but high-risk patients on screening , Auto-CPAP machines post-op can be used short term while drowsiness wears off. Or at least use if they show signs of worsening CO2 retention which can be indirectly measured by VBG or the CO2 (Bicarb) levels on a Basic Metabolic Panel (Both less painful than ABGs). Use narcotics and sedating meds sparingly in these people first couple days post-op. And lastly, after discharge refer them to a outpatient sleep lab for official diagnosis and treatment.
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