Table 6. Perioperative Management of OSA.

General recommendations	Preoperative CPAP
	Preoperative mandibular advancement/oral appliances
	Preoperative weight loss
	Sniffing and ramped up positions for intubation
	Preparation for a difficult intubation
	Minimizing sedatives and opioids, plan for multimodal analgesia
	Considering regional anesthesia techniques whenever possible
	Recovery in the lateral, semiupright or other nonsupine positions
	Postoperative use of CPAP therapy
	Supplemental oxygen as required
	Continuous monitoring with pulse oximetry and capnography
	Incentive spirometry and early ambulation
Specific considerations for various OSA endophenotypes Morbidly obese	Preoperative weight loss
	Preparation for a difficult mask ventilation and intubation
	Ramped up position for intubation
	PAP therapy postextubation
	Screen for OHS, and continued use of special PAP therapy such as CPAP, BPAP, or ASV in preoperative and postoperative period
Craniofacial abnormalities involving maxilla and mandible	Preparation for a difficult mask ventilation and intubation
	Airway adjuncts such as videolaryngoscopes or fiber optic bronchoscopes
	Awake intubation may be considered
	Possible use of dental devices (not tested in perioperative testing)
	Craniofacial surgeries as a long-term therapy
High arousal threshold	Proven in research studies. Feasible method of identification required in future
	Regional anesthesia whenever possible
	Multimodal analgesia
	Short-acting anesthetic agents
	Judicious use of opioids/sedatives
	Continuous postoperative monitoring with high-resolution pulse oximetry
High loop gain	Proven in research studies. Feasible method of identification required in future
	Oxygen therapy beneficial in stabilizing breathing
Supine-related OSA phenotype	Avoidance of supine position
	Semiupright/lateral position for recovery
Fluid overloaded conditions and rostral fluid shift	Potential interventions that may be of benefit:
	Elevated body position
	Diuretics
	Avoidance of excessive fluid administration
	Use of compression stockings to decrease leg fluid volume

Abbreviations: ASV, adaptive servo ventilation; BPAP, bilevel positive airway pressure; CPAP, continuous positive airway pressure; OHS, obesity hypoventilation syndrome; PAP, positive airway pressure.