Authors: Young DJ et al.
Canadian Journal of Anesthesia 72:1558–1583, 2025. Updated version.
Summary
This Continuing Professional Development module provides a practical framework for evaluating and managing adult patients with obstructive sleep apnea (OSA) undergoing ambulatory anesthesia. As outpatient surgery becomes increasingly common, the decision to discharge an OSA patient home the same day requires thoughtful assessment of several risk factors.
The recommended preoperative evaluation focuses on four elements: OSA diagnosis and severity, coexisting cardiorespiratory diseases, the expected physiologic stresses of anesthesia and surgery, and anticipated opioid requirements. Patients with moderate to severe OSA may still be appropriate for ambulatory procedures when surgeries are superficial or peripheral, can be performed under local or regional anesthesia, and postoperative pain can be managed primarily with non-opioid medications.
Patients receiving sedation are at increased risk if long-acting sedatives are used or if postoperative monitoring is insufficient. Therefore, the postanesthesia care unit (PACU) assessment is critical. Before discharge, patients must show no cardiorespiratory signs of OSA-related complications, be comfortable with minimal oral opioid needs, and maintain adequate oxygen saturation while breathing room air. If these conditions are not met, they should not go home and instead require overnight monitoring.
The authors emphasize that while perioperative guidelines for OSA exist, much of the evidence remains low-quality, and higher-level research is needed. Their framework serves as a pragmatic guide to help clinicians make safe, individualized discharge decisions for OSA patients in ambulatory anesthesia settings.
Key Points
• Safe same-day discharge in OSA patients requires a structured risk assessment.
• Better candidates for ambulatory surgery include those undergoing superficial or peripheral procedures with regional or local anesthesia.
• Avoid long-acting sedatives; insufficient recovery time increases risk.
• Before discharge, patients must maintain oxygen saturation on room air and have minimal opioid needs.
• Patients who do not meet these standards require overnight monitoring.
• Higher-quality evidence is needed to strengthen perioperative OSA guidelines.
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