Anaesthesia for Obstructive Sleep Apnea with pregnancy
Hadeer Mosadek Mohamed Youssef;
Abstract
Obstructive Sleep Apnea (OSA)is a sleep disorder that involves cessation or significant decrease in air flow in the presence of breathing effortcharacterized by upper airway collapse & obstruction during sleep.
The prevalence of mild OSA (defined as apnea-hypopnea index (AHI) ≥ 5 events/hour of sleep) was found in 6.5% of the women while moderate to severe OSA (defined as AHI > 15 events/hour of sleep) was 4.4 % with a two fold increase in risk in overweight parturient compared with women of normal weight during pregnancy
The physiological changes (especially hormonal changes) associated with pregnancy may increase the severity of OSA with a higher risk of maternal & fetal morbidity. The most important changes are in the airway, the respiratory and the cardiovascular systems. These changes may lead to increase upper airway resistance, negative pressure, snoring, oxygen desaturation & heart failure during pregnancy.
The pathophysiological mechanisms of OSA in parturients include pharyngeal collapsibility, upper airway dilator muscle activity, arousal from sleep & ventilatory control stability.
OSA is significantly associated with perinatal complications including pregnancy hypertension, caesarean section, thromboembolism, preterm birth, 5-minute Apgar less than 7, admission to neonatal intensive care & congenital malformations.
Very few parturients are diagnosed during pregnancy. If the diagnosis is verified, perioperative CPAP therapy may reduce morbidity in both the mother and baby. Parturients with a low risk of OSA with optimized comorbid conditions may safely receive labour epidural analgesia and may undergo surgery with perioperative OSA precautions. Parturients with a high risk or moderate to severe OSA should be optimised before parturition & regional anaesthesia is preferred.If general anaesthesia is inevitable, special precautions should be taken especially management of difficult intubation. Finally, appropiate postoperative care should be applied to each case according
The prevalence of mild OSA (defined as apnea-hypopnea index (AHI) ≥ 5 events/hour of sleep) was found in 6.5% of the women while moderate to severe OSA (defined as AHI > 15 events/hour of sleep) was 4.4 % with a two fold increase in risk in overweight parturient compared with women of normal weight during pregnancy
The physiological changes (especially hormonal changes) associated with pregnancy may increase the severity of OSA with a higher risk of maternal & fetal morbidity. The most important changes are in the airway, the respiratory and the cardiovascular systems. These changes may lead to increase upper airway resistance, negative pressure, snoring, oxygen desaturation & heart failure during pregnancy.
The pathophysiological mechanisms of OSA in parturients include pharyngeal collapsibility, upper airway dilator muscle activity, arousal from sleep & ventilatory control stability.
OSA is significantly associated with perinatal complications including pregnancy hypertension, caesarean section, thromboembolism, preterm birth, 5-minute Apgar less than 7, admission to neonatal intensive care & congenital malformations.
Very few parturients are diagnosed during pregnancy. If the diagnosis is verified, perioperative CPAP therapy may reduce morbidity in both the mother and baby. Parturients with a low risk of OSA with optimized comorbid conditions may safely receive labour epidural analgesia and may undergo surgery with perioperative OSA precautions. Parturients with a high risk or moderate to severe OSA should be optimised before parturition & regional anaesthesia is preferred.If general anaesthesia is inevitable, special precautions should be taken especially management of difficult intubation. Finally, appropiate postoperative care should be applied to each case according
Other data
| Title | Anaesthesia for Obstructive Sleep Apnea with pregnancy | Other Titles | التخدير لحالات انقطاع النفس الانسدادي النومي مع الحمل | Authors | Hadeer Mosadek Mohamed Youssef | Issue Date | 2017 |
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