État prothrombotique des patients atteints du syndrome d'apnées et d'hypopnées obstructives du sommeil

Obstructive sleep apnea (OSA) is a pathophysiological identity unto itself. Perioperative management of OSA patients includes on the one hand the prevention of postoperative apneas and on the other hand the management of patient's comorbidities (arterial hypertension, obesity, myocardial ischemia, arrhythmia and cerebrovascular accident). Recently, OSA has been linked to an increasing risk of perioperative thromboembolism. The aim of the paper is to review available data linking perioperative thromboembolism and OSA. Numerous modifications of blood homeostasis have been connected to OSA; they can be divided into two entities: the endothelial dysfunction and the hypercoagulable state. The origin of these perturbations is the combination of hypoxia phenomena (ischemia-reperfusion injuries) and the numerous arousals occurring during the sleep of the OSA patients. A nasal continuous positive airway pressure (nCPAP) treatment corrects most of the anomalies and enables the patient to reduce perioperative tromboembolic risks. This paper provides anesthesiologists pathophysiological explanations of the increased risk of thromboembolism in OSA patients as well as measures to prevent or reduce this risk.