Anesthesiologic Management of Adult and Pediatric Patients with Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed condition that significantly increases perioperative morbidity and mortality in both adult and pediatric populations. Its pathophysiology, involving intermittent upper airway obstruction during sleep, poses unique challenges for anesthesiologists due to altered airway anatomy, increased sensitivity to sedatives, and unpredictable ventilatory responses. This comprehensive review summarizes current evidence on the anesthesiologic management of OSA patients, focusing on preoperative screening, risk stratification, intraoperative considerations, and postoperative care. Effective management of OSA requires a multidisciplinary and individualized approach. Preoperative assessment should include validated tools such as STOP-Bang or polysomnography when available. Intraoperative strategies include careful titration of sedatives and opioids, airway protection techniques, and use of short-acting agents. Pediatric patients present specific anatomical and physiological risks, particularly in adenotonsillectomy cases. Postoperative monitoring, especially in the first 24 h, is critical to detect respiratory depression, with CPAP therapy often beneficial in selected patients. Recognizing and appropriately managing OSA in surgical candidates is crucial for improving outcomes and reducing complications. Anesthesiologists should tailor perioperative strategies to the severity of OSA, age group, and type of surgery. Future research should aim to refine predictive tools and establish standardized protocols, particularly in pediatric populations.