Anesthesia Recommendations for the Surgical Management of Obstructive Sleep Apnea Syndrome: A Narrative Review

Background: Obstructive sleep apnea syndrome is a prevalent disorder. Characterized by recurrent upper airway collapse during sleep. Pathophysiologically, the condition results from an imbalance between pharyngeal dilator and occlusive forces, leading to intermittent hypoxia, hypercapnia, and sympathetic activation. Major risk factors include obesity, male sex, advanced age, and anatomical abnormalities such. Clinically, obstructive sleep apnea manifests with loud snoring, witnessed apneas, and excessive daytime sleepiness, and is associated with cardiovascular, metabolic, and neurocognitive sequelae. Continuous positive airway pressure remains the gold standard treatment. Surgical intervention is indicated for patients with a comprehensive preoperative assessment. Key selection criteria include identifiable anatomical obstruction, favorable Friedman staging, low body mass index, and moderate Apnea-Hypopnea Index (AHI). Drug-induced sleep endoscopy (DISE) may allow dynamic airway evaluation to guide personalized surgical planning, utilizing agents such as propofol, dexmedetomidine, or midazolam under controlled sedation. Methodology: A narrative review of the literature in English language is presented, addressing the most common issues on the anesthesia for sleep apnea patients. Results: The literature shows that anesthesia in the surgical management of patients with sleep apnea should be individualized according to the characteristics of each patient and the comorbidities associated with the underlying condition. Conclusions: Anesthetic management demands a multidisciplinary, preventive approach. Preoperatively, systematic screening and optimization of comorbidities are essential. Regional anesthesia is preferred and airway management should employ ramped positioning, maximal preoxygenation, and immediate access to rescue devices. Short-acting anesthetics (e.g., propofol, remifentanil) and complete neuromuscular reversal with sugammadex are recommended. Postoperatively, continuous capnography and pulse oximetry, opioid-sparing multimodal analgesia, semi-recumbent positioning, and early CPAP resumption are critical. Successful outcomes depend on presumptive diagnosis in at-risk patients, minimization of respiratory depression, and vigilant monitoring during the initial 24 postoperative hours.