Effect of sedative-hypnotics, anesthetics and analgesics on sleep architecture in obstructive sleep apnea

Abstract

The perioperative care of obstructive sleep apnea (OSA) patients is currently receiving much attention due to an increased risk for complications. It is established that postoperative changes in sleep architecture occur and this may have pathophysiological implications for OSA patients. Upper airway muscle activity decreases during rapid eye movement sleep (REMS). Severe OSA patients exhibit exaggerated chemoreceptor-driven ventilation during non-rapid eye movement sleep (NREMS), which leads to central and obstructive apnea. This article critically reviewed the literature relevant to preoperative screening for OSA, prevalence of OSA in surgical populations and changes in postoperative sleep architecture relevant to OSA patients. In particular, we addressed three questions in regard to the effects of sedative-hypnotics, anesthetics and analgesics on sleep architecture, the underlying mechanisms and the relevance to OSA. Indeed, these classes of drugs alter sleep architecture, which likely significantly contributes to abnormal postoperative sleep architecture, exacerbation of OSA and postoperative complications.

Keywords::

• analgesia
• anesthesia
• non-rapid eye movement sleep
• obstructive sleep apnea
• opioids
• preoperative screening
• rapid eye movement sleep
• sedative–hypnotic
• sleep architecture
• surgical prevalence

Disclaimer

The content of this review is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Financial & competing interests disclosure

This work was supported, at least in part, by research grants from the NIH, USA to DK Agrawal. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Preoperative screening for obstructive sleep apnea (OSA) is necessary because most patients are undiagnosed.

• OSA is highly prevalent in many surgical subpopulations.

• Postoperatively, rapid eye movement sleep and slow wave sleep decreases initially then returns or rebounds during late postoperative nights, while N2 increases initially then returns.

• Rapid eye movement sleep is associated with decreased pharyngeal muscle activity and increases the risk for obstruction.

• Non-rapid eye movement sleep in severe OSA patients is associated with central apnea leading to further obstruction.

• Sedative-hypnotics, anesthetics and analgesics alter sleep architecture.

• Future research should isolate drug-induced changes in sleep architecture to determine the cause and risks of postoperative sleep architecture changes in OSA patients.

Notes