睡眠呼吸暂停麻醉医师应知道些什么双语

睡眠呼吸暂停麻醉医师应知道些什么双语第一页，共三十三页，编辑于2023年，星期日OSAisadiseasecharacterizedbyrecurrentepisodiccessationofbreathinglasting≥10sduringsleep睡眠时呼吸停止≥10秒，反复发作。Thereisexaggerateddepressionofpharyngealmuscletoneduringsleepandanesthesia,resultinginacyclicalpatternofpartialorcompleteupperairwayobstructionwithimpairedrespiration.睡眠和麻醉过程中咽肌失去张力，导致部分或完全的上气道梗阻气道Thismanifestsasrepeatednocturnalarousalsandincreasedsympatheticoutput,daytimehypersomnolence,memoryloss,andexecutiveandpsychomotordysfunction.反复的夜间觉醒和交感神经兴奋，白天嗜睡，记忆力减退，以及行为和精神运动功能障碍。

Itsestimatedprevalenceare1in4malesand1in10femalesformildOSA，and1in9malesand1in20femalesformoderateOSA.预计的发生率为：轻度OSA男性4人中有1人，女性10人中有1人；中等OSA男性9人中有1人，女性20人中有1人。第二页，共三十三页，编辑于2023年，星期日OSADiagnosticCriteria

Anovernightpolysomnographyorsleepstudy.TheAHIdefinedastheaveragenumberofabnormalbreathingeventsperhourofsleep,isusedtodeterminethepresenceofandtheseverityofOSA.AHI被定义为每小时睡眠的呼吸异常事件的平均数量，是用于确定是否存在OSA及严重程度。Anapneiceventreferstocessationofairflowfor10s,whilehypopneaoccurswithreducedairflowwithdesaturation≥4%呼吸暂停事件：气流停止10s，而血氧至少下降4%.TheAmericanAcademyofSleepMedicine(AASM)diagnosticcriteriaforOSArequireseitheranAHI≥15,orAHI≥5withsymptoms,suchasdaytimesleepiness,loudsnoring,orobservedobstructionduringsleep如白天嗜睡，鼾声如雷，或观察的到的梗阻睡眠TheCanadianThoracicSocietyguidelinesforthediagnosisofOSAspecifiesthepresenceofanAHI≥5onpolysomnography,andeitherof(1)daytimesleepinessor(2)atleast2othersymptomsofOSA(e.g.chokingorgaspingduringsleep,recurrentawakenings,unrefreshingsleep,daytimefatigue).多导睡眠图提示AHI≥5，及（1）白天嗜睡或（2）至少2个其他OSA的症状如睡眠中有窒息或喘息，经常醒来，不能恢复精神的睡眠，白天疲劳。OSAseverityismildforAHI≥5to15,moderateforAHI15to30,andsevereforAHI>30.

第三页，共三十三页，编辑于2023年，星期日ComorbiditiesAssociatedwithOSA

OSA的合并症OSAisassociatedwithmultiplecomorbiditiessuchasmyocardialischemia,heartfailure,hypertension,arrhythmias,cerebrovasculardisease,metabolicsyndrome,insulinresistance,gastroesophagealreflux,andobesity.心肌缺血，心脏衰竭，高血压，心律失常，脑血管疾病，代谢综合征，胰岛素抵抗，胃食管反流，肥胖Variouspathophysiological,demographicandlifestylefactorsalsopredisposetoOSA.Theseincludeanatomicalabnormalitieswhichcauseamechanicalreductioninairwaylumendiameter(e.g.craniofacialdeformities,macroglossia,retrognathia),endocrinediseases(e.g.Cushingdisease,hypothyroidism),connectivetissuediseases(e.g.MarfanSyndrome),malegender,ageabove50years,neckcircumference>40cm,andlifestylefactorsofsmokingandalcoholconsumption.各种病理生理，人口结构和生活方式等因素与OSA有关.包括导致机械降低气道管腔直径的解剖异常（如颅面畸形，巨舌，下颌后缩），内分泌疾病（如皮质醇增多症，甲状腺功能减退），结缔组织病（如马凡氏综合症），男性，年龄50岁以上，颈围>40公分和吸烟、饮酒的生活方式因素第四页，共三十三页，编辑于2023年，星期日PostoperativeComplicationsinPatientswithOSA

OSA患者术后并发症ChronicuntreatedOSAleadstomultisystemicadverseconsequencesandisanindependentriskfactorforincreasedall-causemortalityinthegeneralpopulation.慢性未经治疗的OSA可导致多系统的不良后果，也是普通人死亡率增加的独立危险因素。TheanatomicalinherentcollapsibilityoftheairwayandthesystemiceffectsofthediseasealsoplacethesurgicalOSApatientsatincreasedriskofseriouscomplications.OSA患者气道解剖结构的改变和疾病的全身影响也增加其手术的严重并发症的风险。Memtsoudisetalfounda2XhigherriskofpulmonarycomplicationsinOSApatientsafternon-cardiacsurgeryvsnon-OSA.在非心脏手术中，与非OSA相比OSA患者肺部并发症的风险更高一倍。Inbariatricsurgicalpatients,thepresenceofOSAwasfoundtobeanindependentriskfactorforadversepostoperativeevents.Flinketalreporteda53%incidenceofpostoperativedeliriuminOSApatientsvs20%innon-OSApatients.在减肥手术患者中，OSA是术后不良事件的独立危险因素。弗林克等人报道了53%的OSA患者和20%非OSA患者术后谵妄的发生率。第五页，共三十三页，编辑于2023年，星期日AmetaanalysisbyKawetalshowedthatthepresenceofOSAincreasedtheoddsofpostoperativecardiaceventsincludingmyocardialinfarction,cardiacarrestandarrhythmias(OR2.1),respiratoryfailure(OR2.4),desaturation(OR2.3),ICUtransfers(OR2.8),andreintubations(OR2.1).OSA的存在增加了术后心脏事件However,arecentstudyfoundthatneitheranOSAdiagnosisnorsuspectedOSAwasassociatedwithincreased30-dayor1-yearpostoperativemortality.Also,Mokhlesietalexaminatedlargenationallyrepresentativecohortsinelectiveorthopedic,prostate,abdominalandCVsurgeryin1millionpatientsand90,000patientsundergoingbariatricsurgery.Bothstudiesshowedincreasedcomplicationsbutnotanincreaseinmortality.OSA除了增加死亡率也增加术后并发症。GiventhebodyofevidenceassociatingadiagnosisofOSAwithadverseperioperativeoutcomes,precautionsshouldbetakenperioperativelytoreducecomplicationsinthisvulnerablegroupofpatients.鉴于OSA的诊断与围手术期不良事件的相关性，应采取预防措施，减少这一弱势群体患者的围手术期的并发症第六页，共三十三页，编辑于2023年，星期日PreoperativeEvaluationofthePatientwithDiagnosedOSA

OSA患者的术前评估Athoroughhistoryandphysicalexaminationareessential.FocusedquestionsregardingOSAsymptomsshouldbeasked.PolysomnographyresultsshouldbereviewedtoconfirmthediagnosisofOSAandevaluatetheseverityofthedisease.PatientswithlongstandingOSAmaymanifestamyriadofsignsandsymptomssuggestingthedevelopmentofsystemiccomplications,suchashypoxemia,hypercarbia,polycythemiaandcorpulmonale.彻底的病史和体格检查是必不可少的。与OSA症状相关的问题应被询问到。多导睡眠监测结果应进行复习以确认OSA的诊断和评估疾病的严重程度。在长期的OSA患者会表现出各种的体征和症状，提示系统性并发症的发展，如缺氧，高碳酸血症，红细胞增多症和肺心病。第七页，共三十三页，编辑于2023年，星期日Thepatientshouldalsobeassessedforsignificantcomorbiditiesincludingmorbidobesity,uncontrolledhypertension,arrhythmias,cerebrovasculardisease,heartfailureandmetabolicsyndrome.Obesityhypoventilatonsyndromeoccursin0.15-0.3ofthegeneralpopulation.PulmonaryarterialhypertensionisafairlycommonlongtermcomplicationofOSA,occurringin15-20%ofpatients.Itssignificanceliesinthefactthatcertainphysiologicalderangementsmayraisepulmonaryarterypressuresfurtherandshouldbeavoidedintraoperatively.应评估重要的合并症包括病态肥胖，未控制的高血压，心律失常，脑血管疾病，心脏衰竭，代谢综合征。肥胖低通气综合征发生在普通人群中的0.15-0.3。肺动脉高压是OSA相当常见的长期并发症，发生率达15-20％。其意义在于某些生理紊乱可提高肺动脉压力，术中应进一步避免。TheAmericanCollegeofChestPhysiciansdoesnotrecommendroutineevaluationforpulmonaryarterialhypertensioninpatientswithknownOSA.However,shouldtherebeanticipatedintraoperativetriggersforacuteelevationsinpulmonaryarterialpressures,forexample,highrisksurgicalproceduresoflongduration,apreoperativetransthoracicechocardiographymaybeconsidered.美国胸科医师不建议常规评估已知的OSA患者肺动脉高压。然而，如果有预期的术中的触发在肺动脉压力急性升高的因素，例如，持续时间长的高风险的外科手术，可考虑做术前经胸超声心动图检查以评估肺动脉高压。第八页，共三十三页，编辑于2023年，星期日

SimplebedsideinvestigationsmaybeperformedinthepreoperativeclinictoscreenforOSArelatedcomplications.Intheabsenceofotherattributablecausesforhypoxemia,abaselineoximetryreadingof≤94%onroomairsuggestsseverelongstandingOSA,andmaybearedflagsignalingpostoperativeadverseoutcome术前进行的简单的床头调查可能筛查出OSA相关的并发症。没有其他原因引起低氧血症，室内空气下血氧≤94％，表明存在严重的长期的OSA，并可能是标志着术后不良事件的红色信号第九页，共三十三页，编辑于2023年，星期日ThecomplianceofOSApatientstosuchtreatmentshouldbeevaluated.Thepatient’supdatedPAP(Positiveairwaypressure)therapysettingsshouldbeobtained.Reassessmentbyasleepmedicinephysicianmaybeindicatedinpatientswhohavedefaultedfollowup,havebeennon-complianttotreatment,havehadrecentexacerbationofsymptoms,orhaveundergoneupperairwaysurgerytorelieveOSAsymptoms.PatientswhodefaultPAPuseshouldbeadvisedtoresumetherapy.OSA患者的治疗依从性应评估.病人的最新PAP治疗的设置应该得到的。通过睡眠医师的重新评估可表明：谁放弃治疗，谁不按规定治疗，谁近期症状加重，谁进行了上气道手术来缓解OSA症状。放弃PAP治疗的患者应建议其恢复治疗。第十页，共三十三页，编辑于2023年，星期日Interestingly,thereistodateinsufficientevidencetoproveconclusivelythebenefitofPAPtherapyinthepreoperativesetting;andthedurationoftherapyrequiredtoeffectivelyreduceperioperativeriskshasnotbeendelineated.有趣的是，迄今没有足够的证据证明在术前PAP治疗的获益；以及有效地减少围手术期的风险，治疗所需的时间尚未确定。

ArecentstudyshowedthatthepreoperativepatientsidentifiedtohaveOSAandtreatedwithCPAPhavelongtermhealthbenefitsintermsofimprovedsnoring,sleepquality,daytimesleepinessandreductionofmedicationsforcomorbidites.However,adherencetoprescribedCPAPtherapyduringtheperioperativeperiodwasextremelylow.最近的一项研究表明，术前确诊为OSA并进行CPAP治疗在长期改善打鼾，睡眠质量，白天嗜睡和减少合并症的用药有意义。然而，在围手术期遵守规定给予CPAP治疗者非常少。第十一页，共三十三页，编辑于2023年，星期日CurrentguidelinesrecommendthatpatientswithmoderateorsevereOSAalreadyonPAPtherapyshouldcontinuePAPusepriortosurgery.目前的指南建议中度或重度OSA已经进行PAP治疗者应该继续治疗至手术前。

Theanesthesiateamshouldbeinformedearlytoallowforadvancedintraoperativemanagementplanningandriskmitigation.麻醉团队应被提前告知以便制定更好的术中管理计划降低手术风险

MildOSAmaynotbeasignificantdiseaseentityforpatientsundergoingsurgeryandanesthesia.轻度OSA患者不是暂停手术和麻醉的实质疾病。FromthepublishedresultsoftheBusseltonHealthCohortStudy,mildOSAwasnotanindependentriskfactorforhighermortalityinthegeneralpopulation.轻度的OSA不是增加普通人群死亡率的独立危险因素。

BasedonexpertopinionandsymptomatologyofOSApatients,preoperativePAPusemaynotbeindicatedinpatientswithmildOSA.PAP不是轻度OSA患者治疗的指征。第十二页，共三十三页，编辑于2023年，星期日MethodsforPerioperativeScreeningforOSA

对OSA的围手术期的筛选方法PSG多导睡眠监测金标准昂贵questionnaire-basedmethodstheEpworthSleepinessScale,theBerlinQuestionnaire,theASAchecklist,theSleepApneaClinicalScore,theP-SAPscoreandtheSTOP-Bangquestionnaire.

第十三页，共三十三页，编辑于2023年，星期日第十四页，共三十三页，编辑于2023年，星期日Table1:ObstructiveSleepApneaScreeningQuestionnaire–STOP-BangSnoring:Doyousnoreloudly(louderthantalkingorloudenoughtobeheardthroughcloseddoors)?YesNoTired:Doyouoftenfeeltired,fatigued,orsleepyduringdaytime?YesNoObserved:Hasanyoneobservedyoustopbreathingduringyoursleep?YesNoBloodPressure:Doyouhaveorareyoubeingtreatedforhighbloodpressure?YesNoBMI:BMImorethan35kg/m2?YesNoAge:Ageover50yearsold?YesNoNeckcircumference:Neckcircumferencegreaterthan40cm?YesNoGender:Male?YesNoLowriskofOSA:Yes0-2AtriskofOSA:Yes3ormorequestionsHighriskofOSA:Yes5-8第十五页，共三十三页，编辑于2023年，星期日PatientswithSTOP-Bangscores0-2maybeconsideredlowrisk,3-4intermediaterisk,and5-8highriskofOSA.Apnea/hypopneaduringsleepcanleadtointermittenthypercapniaandresultinserumbicarbonateretention.TheadditionofserumbicarbonateleveltotheSTOP-Bangquestionnairemayimproveitsspecificity.TheSTOP-BangquestionnaireisusefulinthepreoperativesettingtopredictOSAseverity,triagepatientsforfurtherconfirmatorytesting,andexcludethosewithoutdisease。得分0-2可能是低风险，3-4中间风险，和5-8OSA的高危人群。睡眠时呼吸暂停/低通气可导致间歇性高碳酸血症，导致血清碳酸氢盐潴留。增加血清碳酸氢盐水平，以STOP-Bang调查问卷可提高术前OSA诊断的特异性，STOP-Bang问卷有利于评估OSA的严重程度，筛选出一些病人作进一步确定性测试，并排除那些没有OSA的病人。第十六页，共三十三页，编辑于2023年，星期日PreoperativeEvaluationofthePatientwithSuspectedOSA

疑似OSA患者的术前评估InpatientssuspectedofOSA,athoroughclinicalexaminationshouldbeperformedwithemphasisonpertinentsymptomsandsignsofOSA.在疑似OSA患者的，彻底的临床检查应着重于与OSA相关的症状和体征Thesubsequentmanagementisdeterminedbytheurgencyofsurgery.后续的处理取决于手术的紧迫性Wherenon-urgentelectivesurgeryisplanned,thedecisionforfurtherevaluationrestson(1)theriskofsurgery,and(2)thepresenceofothersignificantcomorbiditiessuggestiveofchronicOSA,suchasuncontrolledhypertension,heartfailure,arrhythmias,pulmonaryhypertension,cerebrovasculardisease,morbidobesityandmetabolicsyndrome.计划非紧急的择期手术时，作出进一步评价这一决定取决于（1）手术的风险，（2）OSA其他明显并发症的存在ForpatientswithSTOP-Bangscore5-8,scheduledformajorelectivesurgery,andhavecomorbiddisease(s)associatedwithlongstandingOSA,apreoperativeassessmentbythesleepphysicianandapolysomnographyshouldbeconsideredfordiagnosisandtreatment患者STOP-Bang得分5-8，进行重大手术，长期的OSA相关的合并症，术前评估应考虑进行多导睡眠检查和睡眠医师协助诊断和治疗第十七页，共三十三页，编辑于2023年，星期日Sometimes,majorelectivesurgerymayhavetobedeferredtoallowadequateevaluationandoptimizationofsuspectedsevereOSA.有时大的择期手术可能被推迟，以便进行足够的术前评估及疑似严重OSA患者的身体的优化。Wesuggestthatpatientsscoredashighriskbutwithoutsignificantcomorbiditiesbeconsideredforfurtherevaluationwithportablemonitoringdevices,orproceedwithsurgerywithapresumeddiagnosisofmoderateOSAandwithperioperativeOSAprecautions.Thesepatientscanbereferredaftersurgery我们建议高危但无明显合并症患者可以使用便携式设备进一步评估，或对疑似中等程度的OSA患者继续进行手术，但围手术期采取针对OSA的预防措施。这些病人可以监测直到术后第十八页，共三十三页，编辑于2023年，星期日PortablePolysomnographyandOvernightOximetry

便携式多导睡眠图和夜间血氧饱和度仪Thelevel2portablepolysomnographyhasbeenshowntohaveadiagnosticaccuracysimilartostandardpolysomnography,whilenocturnaloximetryisbothsensitiveandspecificfordetectingOSAinSTOP-Bangpositivesurgicalpatients.2级的便携式多导睡眠图已被证明与标准多导睡眠诊断有一致的准确性，而夜间血氧饱和度在STOP-Bang阳性的手术患者中鉴别出OSA有一定的敏感和特异性TheoxygendesaturationindexderivedfromnocturnaloximetrycorrelateswellwiththeAHIobtainedfrompolysomnography.Furthermore,patientswithmeanpreoperativeovernightSpO2<93%orODI>28.5events/hareathigherriskforpostoperativeadverseevents.夜间血氧饱和度仪所得到的氧饱和度指数与多导睡眠监测获得的AHI很好的相关性。患者术前平均血氧饱和度过夜<93％或ODI>28.5次/h在手术后不良事件发生的风险较高。第十九页，共三十三页，编辑于2023年，星期日ThePortableMonitoringTaskForceoftheAmericanAcademyofSleepMedicine(AASM)suggeststhatportabledevicesmaybeconsideredwhenthereishighpretestlikelihoodformoderatetosevereOSAwithoutothersubstantialcomorbidities.AASM建议在中度至重度OSA没有其他实质性合并症的患者考虑使用便携式设备。TheCanadianThoracicSociety2011updateonthediagnosisandtreatmentofsleepdisorderedbreathingrecommendedthatlevel2,3and4portablemonitoringdevicesincludingnocturnaloximetrymaybeusedasconfirmatorytestsforthediagnosisofOSA,providedthatproperstandardsforconductingthetestandinterpretationofresultsaremet.CTS提出如果正确地进行测试并对结果进行解释，那么2级，3和4的便携式监测设备包括夜间血氧饱和度可作为诊断为OSA的确认测试。第二十页，共三十三页，编辑于2023年，星期日IntraoperativeRiskReductionStrategiesforOSAPatientsOSA患者围手术期预防和减少风险措施AnestheticConcernPrinciplesofManagementPremedication术前用药PremedicationAvoidsedatingpremedication避免术前用药术前镇静ConsiderAlpha-2adrenergicagonists(clonidine,dexmedetomidine)考虑α-2肾上腺素受体激动剂（可乐定，右美托咪）Potentialdifficultairway(difficultmaskventilationandtrachealintubation)潜在的困难气道（困难的面罩通气和气管插管）OptimalpositioningHeadelevatedlaryngoscopypositionifpatientobese最佳位置肥胖病人头部垫高喉镜的位置Adequatepreoxygenation充分预吸氧ConsiderCPAPpreoxygenation考虑CPAP预吸氧Two-handedtripleairwaymaneuvers(见注）双手三气道操作法Anticipatedifficultairway.Personnelfamiliarwithaspecificdifficultairwayalgorithm预见困难气道。熟悉特殊困难气道的处理流程注：1slightneckextension;2elevationofthemandible3mouthopening第二十一页，共三十三页，编辑于2023年，星期日Gastroesophagealrefluxdisease胃食管反流病

Considerprotonpumpinhibitors,antacids,rapidsequenceinductionwithcricoidpressure考虑质子泵抑制剂，抗酸剂，快速诱导并环状软骨压迫

Opioid-relatedrespiratorydepression阿片类药物相关的呼吸抑制Minimizeopioiduse减少阿片类药物的使用Useofshort-actingagents(remifentanil)使用短效药物（瑞芬太尼）Multimodalapproachtoanalgesia(NSAIDs,acetaminophen,tramadol,ketamine,gabapentin,pregabalin,dexmedetomidine,clonidine,Dexamethasone,melatonin)多模式镇痛（NSAIDs，对乙酰氨基酚

，曲马多，氯胺酮，加巴喷丁，普瑞巴林，右美托咪定，可乐定，地塞米松，褪黑激素）Considerlocalandregionalanesthesiawhereappropriate适当的考虑局部和区域麻醉第二十二页，共三十三页，编辑于2023年，星期日Carry-oversedationeffectsfromlonger-actingintravenousandvolatileanestheticagents长效的静脉麻醉药物和挥发性麻醉药的遗留效应Useofpropofol/remifentanilformaintenanceofanesthesia丙泊酚/瑞芬太尼进行麻醉维持Useofinsolublepotentanestheticagents(desflurane)利用不溶性的强效麻醉剂（地氟醚）Useofregionalblocksasasoleanesthetictechnique利用区域阻滞为唯一的麻醉技术Excessivesedationinmonitoredanestheticcare监测麻醉时的过度镇静Useofintraoperativecapnographyformonitoringofventilation术中应监测PetCO2了解通气的情况Post-extubationairwayobstruction拔管后气道阻塞verifyfullreversalofneuromuscularblockade肌松作用完全拮抗extubateonlywhenfullyconsciousandcooperative意识清楚、合作Non-supinepostureforextubationandrecovery非仰卧姿势拔管和复苏准备ResumeuseofPAPdeviceaftersurgery手术后恢复使用PAP设备第二十三页，共三十三页，编辑于2023年，星期日PostoperativeDispositionofKnownandSuspectedOSAPatientsafterGeneralAnesthesiaThepostoperativedispositionoftheOSApatientwilldependonthreemaincomponents:theinvasivenessofthesurgery,theseverityofOSA,andtherequirementforpostoperativeopioids.OSA患者的术后处置将取决于三个主要组成部分：手术的级别，OSA的严重程度，及术后阿片类药物需求Thefinaldecisionregardingthelevelofmonitoringisdeterminedbytheattendinganesthesiologist,takingintoaccountallpatient-related,logisticalandcircumstantialfactors.对于监测水平，最终的决定由麻醉医师决定，应考虑到病人相关症状，经济和环境因素。第二十四页，共三十三页，编辑于2023年，星期日AllpatientswithknownorsuspectedOSAwhohadreceivedgeneralanesthesiashouldhaveextendedmonitoringinPACUwithcontinuousoximetry.所有曾接受全身麻醉的已知或怀疑OSA患者在PACU中应继续血氧饱和度监测Therearecurrentlynoevidence-basedguidelinesaddressingtheoptimallengthofmonitoringrequiredinPACU.没有明确的循证指南指导PACU的最佳监测时间TheASAguidelines,whichwerebasedonexpertopinion,recommendedprolongedobservationfor7hoursinPACUifrespiratoryeventssuchasapneaorairwayobstructionoccur.ASA指南推荐若呼吸事件如呼吸暂停或气道阻塞出现，PACU观察延长至7小时。

Suchrecommendationsaredifficulttoadhereto,especiallyinthecontextofcommunityhospitals.WeproposeextendedPACUobservationforanadditional30-60minutesinaquietenvironmentafterthemodifiedAldretecriteriafordischargehasbeenmet.这些建议是很难坚持的，尤其是在社区医院。我们建议如果患者能满足改良Aldrete出院的评分标准，那么仅需额外的30-60分钟PACU观察时间。第二十五页，共三十三页，编辑于2023年，星期日第二十六页，共三十三页，编辑于2023年，星期日TheoccurrenceofrecurrentrespiratoryeventsinPACUisanotherindicationforcontinuouspostoperativemonitoring.在PACU中复发的呼吸事件是继续术后监测的另一个指征。PACUrespiratoryeventsare:(1)episodesofapnea≥10seconds,(2)bradypnea<8breaths/min,(3)pain-sedationmismatch,or(4)repeatedO2desaturation<90%.Anyoftheaboveeventsoccurringrepeatedlyinseparate30-minuteintervalsmaybeconsideredrecurrentPACUrespiratoryevents.PACU呼吸事件：（1）暂停≥10秒发作，（2）呼吸徐缓＜8次／分，（3）疼痛镇静不匹配，或（4）重复血氧＜90%。上述事件重复出现在单独的30分钟的时间间隔，可以认为复发的PACU呼吸事件PatientswithsuspectedOSAandwhodeveloprecurrentPACUrespiratoryeventsareatincreasedriskofpostoperativerespiratorycomplications.增加术后气道并发症的风险Continuousmonitoringwithoximetryinaunitwithreadyaccesstomedicalinterventionisadvocated.ThesewouldincludeICU,stepdownunits,orthesurgicalwardequippedwithremotetelemetryandoximetrymonitoring.ThesepatientsmayrequirepostoperativePAPtherapy.提倡在重症监护病房，二级病房（手术暂留区）或外科病房连续监测血氧饱和度以便随时获得医疗干预。这些患者可能需要手术后PAP治疗第二十七页，共三十三页，编辑于2023年，星期日OneshouldconsiderdischargingapatientwithknownOSAtoamonitoredenvironmentifthepatienthassevereOSA,isnon-complianttoPAPtherapy,orhasrecurrentPACUrespiratoryevents.如果病人有严重的OSA，而没有进行规范的PAP治疗，或有复发的PACU呼吸事件,应该考虑其监控环境Monitoringwithcontinuousoximetryisrecommendedwithparenteralopioidsduetopossibledruginducedrespiratorydepression.肠外阿片类药物可能引起呼吸抑制，推荐连续血氧饱和度监测

PatientswithmoderateOSAwhorequirehighdoseoralopioidsshouldbemanagedinasurgicalwardwithcontinuousoximetryregardlessofthenumberofPACUrespiratoryevents.无论PACU呼吸事件的数目多少，需要大剂量口服阿片类药物治的中度OSA患者应在外科病房进行连续血氧饱和度的监测。第二十八页，共三十三页，编辑于2023年，星期日KnownOSApatientsalreadyonPAPdevicesshouldcontinuePAPtherapypostoperatively，maymitigatetheriskofpostoperativecomplications.已知的已使用PAP设备的OSA患者术后应继续PAP治疗，可以减轻术后并发症的风险Amultimodalapproachtoanalgesiashouldbeemployedtominimizetheuseofopioidspostoperatively.应用多模式镇痛减少术后阿片类药物的使用。Ifpostoperativeparenteralopioidsarenecessary,considerationshouldbemadefortheuseofpatientcontrolledanalgesiawithnobasalinfusionandastricthourlydoselimit,asthismayhelpreducethetotalamountofopioidused.如果术后的肠外阿片类药物是必要的，应考虑使用PCA，但不使用基础输注量并严格限制每小时剂量，这可能有助于减少阿片类药物使用的总量。OSApatientsmayhaveanupregulationofthecentralopioidreceptorssecondarytorecurrenthypoxemia,andarethereforemoresusceptibletotherespiratorydepressanteffectsofopioids.Assuch,theymaybenefitfromsupplementaloxygenwhileonparenteralopioids.OSA患者反复低氧血症后可能继发中枢阿片受体上调，更容易受到阿片类药物的呼吸抑制作用。因此，肠外阿片类药物使用时患者应进行吸氧。第二十九页，共三十三页，编辑于2023年，星期日AnesthesiologistsshouldconsiderthefactorsandeventsassociatedwithhigherriskofcomplicationsfromOSA,diagnosticfollow-upandpossiblesleepmedicineconsult.麻醉医师需关注OSA患者并发症的高危因素和事件，跟进诊断和睡眠专科医师会诊Fortheperioperativemanagement,itisimportanttoeducatesurgeons,nurses,patients,andtheirfamily.Pharmacyinvolvementtopreventmultipledrugswithpotentialtocausesedationandlimitingtheupperdoseofopioidsisessential.Nursetrainingindetectingrespiratorydepressionandinrapidadministrationofnaloxonewillpreventmortalityandmorbidity.对于围手术期管理，外科医生，护士，患者和他们的家属共同学习认知是很重要的。药店参与，在避免多种镇静药物使用和控制阿片类药物的剂量上是必不可少的。训练护士发现呼吸抑制和纳洛酮快速给药可以防止死亡率和发病率。第三十页，共三十三页，编辑于2023年，星期日PreoperativeAHI,malegenderand72hopioiddosewerepositivelyassociatedwithpostoperativeAHI.术前的AHI，男性及72h内的阿