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Letters to the Editor: Letter to the Editor

The Elephant in the Room Is Bigger Than You Think

Finding Obstructive Sleep Apnea Patients Dead in Bed Postoperatively

Benumof, Jonathan L. MD

Author Information
doi: 10.1213/ANE.0000000000000461
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To the Editor

The recent editorial by Brown et al.1 and articles by Cote et al.2 and Goldman et al.3 highlight the tragedy of finding pediatric patients with obstructive sleep apnea (OSA) dead in bed (DIB) at home after adenotonsillectomy (“the elephant in the room,” as defined by Brown et al.).1 The OSA-DIB “elephant in the room” problem, however, is significantly larger, involving all patients with severe OSA undergoing all operations.

More specifically, the prototypical DIB case is a morbidly obese adult patient with severe OSA and a painful incision who is receiving opioids and in an isolated environment without continuous electronic monitoring, continuous oxygen supplementation, and continuous positive airway pressure.

The Society for Anesthesia and Sleep Medicine was formed in 2010 and tasked a multidisciplinary committee to create a national registry of OSA-DIB and “near-miss” cases to provide “insight regarding the scope,” identify “factors associated with the problem,” and determine “what can be done to limit these adverse events.” The OSA-DIB “near-miss” registry is cosponsored by the Anesthesia Quality Institute. All cases should be submitted to the registry committeea via completion of a detailed questionnaire for approval and inclusion into the database.

Jonathan L. Benumof, MD

Department of Anesthesiology

UCSD Medical Center

San Diego, California

[email protected]


a Available at: Accessed January 2015
Cited Here


1. Brown KA, Brouillette RT. The elephant in the room: lethal apnea at home after adenotonsillectomy. Anesth Analg. 2014;118:1157–9
2. Coté CJ, Posner KL, Domino KB. Death or neurologic injury after tonsillectomy in children with a focus on obstructive sleep apnea: Houston, we have a problem! Anesth Analg. 2014;118:1276–83
3. Goldman JL, Baugh RF, Davies L, Skinner ML, Stachler RJ, Brereton J, Eisenberg LD, Roberson DW, Brenner MJ. Mortality and major morbidity after tonsillectomy: etiologic factors and strategies for prevention. Laryngoscope. 2013;123:2544–53
© 2015 International Anesthesia Research Society