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Society of Anesthesia and Sleep Medicine Guidelines on Preoperative Screening and Assessment of Adult Patients With Obstructive Sleep Apnea

Chung, Frances MBBS, FRCPC; Memtsoudis, Stavros G. MD, PhD; Ramachandran, Satya Krishna MD; Nagappa, Mahesh MD; Opperer, Mathias MD; Cozowicz, Crispiana MD; Patrawala, Sara MD; Lam, David BSc; Kumar, Anjana BSc; Joshi, Girish P. MD; Fleetham, John MD; Ayas, Najib MD; Collop, Nancy MD; Doufas, Anthony G. MD, PhD; Eikermann, Matthias MD, PhD; Englesakis, Marina HBA, MLIS; Gali, Bhargavi MD; Gay, Peter MD; Hernandez, Adrian V. MD, PhD; Kaw, Roop MD; Kezirian, Eric J. MD, MPH; Malhotra, Atul MD; Mokhlesi, Babak MD; Parthasarathy, Sairam MD; Stierer, Tracey MD; Wappler, Frank MD; Hillman, David R. MD; Auckley, Dennis MD

doi: 10.1213/ANE.0000000000001416
Respiration and Sleep Medicine: Special Article

The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of adult patients with obstructive sleep apnea (OSA) is to present recommendations based on the available clinical evidence on the topic where possible. As very few well-performed randomized studies in this field of perioperative care are available, most of the recommendations were developed by experts in the field through consensus processes involving utilization of evidence grading to indicate the level of evidence upon which recommendations were based. This guideline may not be appropriate for all clinical situations and all patients. The decision whether to follow these recommendations must be made by a responsible physician on an individual basis. Protocols should be developed by individual institutions taking into account the patients’ conditions, extent of interventions and available resources. This practice guideline is not intended to define standards of care or represent absolute requirements for patient care. The adherence to these guidelines cannot in any way guarantee successful outcomes and is rather meant to help individuals and institutions formulate plans to better deal with the challenges posed by perioperative patients with OSA. These recommendations reflect the current state of knowledge and its interpretation by a group of experts in the field at the time of publication. While these guidelines will be periodically updated, new information that becomes available between updates should be taken into account. Deviations in practice from guidelines may be justifiable and such deviations should not be interpreted as a basis for claims of negligence.

From the *Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Anesthesiology, Weill Cornell Medical College and Hospital for Special Surgery, New York, New York; Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan; §Department of Anesthesiology and Perioperative Medicine, University Hospital, St. Joseph’s Hospital and Victoria Hospital, London Health Sciences Centre and St. Joseph’s Health care, Western University, London, Ontario, Canada; Paracelsus Medical University, Department of Anesthesiology, Perioperative Medicine and Intensive Care, Salzburg, Austria; Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College New York, New York; #Department of Anesthesia, Perioperative Medicine and Intensive Care, Paracelsus Medical University, Salzburg, Austria; **Department of Medicine, University of California San Diego, San Diego, California; ††Sparrow Hospital, Lansing, Michigan; ‡‡Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Texas; §§Department of Medicine, Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada; ‖‖University of British Columbia, Vancouver, BC, Canada; ¶¶Department of Medicine, Emory University, Atlanta, Georgia; ##Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Palo Alto, California; ***Department of Anesthesia, Critical Care and Pain Medicine, Harvard University, Cambridge, Massachusetts; †††Library and Information Services, University Health Network, University of Toronto, Toronto, Ontario, Canada; ‡‡‡Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota; §§§Department of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota; ‖‖‖School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru; ¶¶¶Departments of Hospital Medicine and Outcomes Research (Anesthesiology Institute), Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio; ###USC Caruso Department of Otolaryngology—Head & Neck Surgery Keck School of Medicine of USC Los Angeles, California; ****Division of Pulmonary and Critical Care Medicine, University of California San Diego, San Diego, California; ††††Section of Pulmonary and Critical Care, University of Chicago, Chicago, Illinois; ‡‡‡‡Department of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Arizona, Tucson, Arizona; §§§§Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland; ‖‖‖‖Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Cologne, Germany; ¶¶¶¶Department of Paediatric Anaesthesia, Cologne Medical Centre, Cologne, Germany; ####Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, University of Western Australia, Nedlands, Australia; and *****Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Case Western Reserve University, School of Medicine, Cleveland, Ohio.

Accepted for publication April 23, 2016.

Funding: None.

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Address correspondence to Frances Chung, MBBS, FRCPC, Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St, McL 2-405, Toronto, ON, Canada M5T 2S8. Address e-mail to

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© 2016 International Anesthesia Research Society