Morbid obesity, sleep apnea, obesity hypoventilation syndrome: Are we sleepwalking into disaster?

An increase in the prevalence of obesity globally has been associated with the increase in sleep disordered breathing conditions (SBD) like obstructive sleep apnea and obesity hypoventilation syndrome. These high-risk patients are prone for increased perioperative morbidity and mortality because of associated comorbid conditions, difficult intubation and postoperative cardiorespiratory complications. However, a significant number of patients with SDB are not diagnosed at the time of surgery due to lack of awareness among perioperative team members. Identification of these high-risk patients and optimizing them preoperatively may improve the perioperative outcome. Various perioperative organizations have made guidelines on managing patients with morbid obesity and sleep disordered breathing. Every hospital should have a written policy on preoperative assessment, intraoperative and postoperative management of obese patients with sleep disordered breathing.