Causes

• central apnea
  • loss of CNS drive
  • Ondines's curse
• obstructive (mechanical)

Manifestations

• daytime sleepiness
• history of loud snoring
• obesity
• hypertension
• arterial hypoxemia
• polycythemia
• hypercarbia
• cor pulmonale

Surgical treatment

• uvulopalatophyaryngoplasty (UPP)
• genioglossal advancement
• maxillo-mandibular advancement
• tracheostomy

Anesthesia

• BEWARE: exquisite sensitivity to CNS depressants leading to upper airway obstruction, hypoventilation
• avoid preop sedation
• minimize use of opioids (including neuraxial opioids)
• use short acting medications
• consider role of awake (fiberoptic) intubation
• delay extubation until patient is awake
• consider regional anesthesia/analgesia
• consider postoperative local anesthetics, nonopioid analgesics
• postop, monitor respirations, SpO₂

CEA Aneurysm Tumor Apnea Cord References
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