As a person with OSA, it is essential that you make your physicians and medical staff aware of your OSA anytime you have hospital stays or undergo medical procedures, regardless if those procedures are performed in or out of a hospital.  Be aware that many outpatient surgical centers will not accept OSA patients.  Not making medical staff aware of your OSA may delay your healing, increase your pain sensitivity and put your life at risk.  Even if medical staff are aware of your OSA, it is important that you go over with your doctors and staff how your OSA will be controlled and treated during your stay and/or procedure.

Please read these excellent articles on CPAP use for hospital/surgical OSA patients.

Sleep Apnea and Same Day Surgery

CPAP Use in a Hospital or Surgical Setting:  An OSA Patient's Rights and Responsibilities

Hospital Checklist for OSA Patients


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Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Von Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

also put your name and address on your CPAP otherwise it may be lost or mixed with some other patients CPAP


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resmed S6 lightweight, respironics comfort gell mask using CPAP since 1995, no humidifier
during my many years of undiagnosed severe fatigue, no doctor ever asked me if I snored

I had surgery in May and was told by the surgeon to bring my CPAP machine.  The biggest problem was none of the nurses seemed to know anything about the machine or how it worked and by the time I realized this they already had me on the table and strapped down.  The nurses were finally able to get it figured out but you may want to make sure they know how to work everything before it's too late.  Brett

I just had my appendix out ..it was an emergency ..I told the doctor I had apnea before they put me out ..while I was in the operating room my husband went home and got my bipap and I hooked it up after the operation all went well and I was home in about 14 hours.

If you accept the fact that up to 90% of people with sleep apnea are not diagnosed, that means that there are LOTS of people undergoing surgery or being admitted to the hospital with undiagnosed sleep apnea. Having been in many harrowing airway emergency situations in the operating room, I can tell you that there's nothing more than an airway emergency that gets your heart racing. It's worse than bleeding. The reason that sleep apnea patients have more difficulties in the OR is that due to the small jaws, it's sometimes difficult to see the airway when placing intubation tubes. Things can also go downhill immediately after the tube is out, with the patient somewhat relaxed. Getting the tube back in can be very difficult. There are protocols in place to prevent these difficult airway situations, such as having a fiberoptic intubation tray ready, extubating the patient wide awake, and generous use of oral or nasal-oral airways. My feeling is that we have to assume that ALL patients have sleep apnea.

What about patients in hospitals? If you already have a sleep apnea diagnosis, it's one thing to let the staff or your doctor know, but what if you get admitted and don't know that you have obstructive sleep apnea? First of all, many people with sleep apnea prefer to  sleep on their sides or stomachs, but hospital protocol dictates that you MUST sleep on your back. This is enforced by strapping you to multiple wires, leads, and sometimes even casts. After even minor operations, you're forced to sleep on your back. If you're a side or stomach sleeper, being forced to suddenly sleep on your back will be a miserable experience. Plus if you have more apneas while on your back, you tend to aspirate more stomach juices into the throat, which can then go down into the lungs and cause pneumonia. This is why hospital patients get more pneumonias.

Another frightening situation that I noticed during my surgical internship is that many normal, relatively healthy people will have heart attacks on my shift. Much more so than what occurs in the normal population. If you normally sleep on your stomach and are suddenly forced to sleep on your back due to a hip operation, you'll definitely have more apneas, stressing your heart beyond what your heart can normally handle. Think about the implications. Should we screen for sleep apnea before any hospital admission? I was thinking about doing a prospective study where patient are asked about their sleep position on admission. Follow them for the duration of the admission and track the complication rates. I'm willing to bet that the side and stomach sleepers will have a MUCH higher complication rate.


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Steven Y. Park, M.D.
http://www.doctorstevenpark.com

How does this apply to persons getting procedures or tets done under conscious sedation, such as a colonoscopy exam, I know I always have a difficult time in the recovery, and the last time I had it done, I had only been diagnosed with SA for a couple of months and they did nothing, special except I always end up staying longer in the recovery than anybody else! Heck they didn't even  monitor my O2 sat, but everyone commented on how loud I snored and gasped!
 Now a month or so later when I had one day surgery to have my Gallbladder taken out,  in the recovery room they would yell at me to breath every time  the O2 sat alarm would go off, which was all the time, but they did not let me use my BiPAP machine, even  after they decided to keep me over night. By the way I was told to bring my BiPAP machine with me to the hospital which I did, but I never got a chance to use it!
Now this coming January I am due to have another colonoscopy,  again it is the conscious sedation thing, and now my Sleep apnea is being successfully treated with  the VPAP ASV  with 3 L. supplemental O2. They know about my sleep apnea, they did nothing about it before, and before I didn't know much about Sleep apnea either.  ( I guess ignorance  really is bliss!) But now I am more educated on it and after reading this stuff, well let us say I am a little more than concerned  or apprehensive about having this procedure done! Does the same rules apply for conscious sedation as it does for general anesthesia? And how does this apply to patients with Central and Complex sleep apnea?


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White Beard with a White Beard
Resmed VPAP Adapt SV Enhanced, HumidAire 2i, ResLink with Model 8000 Flex sensor Pulse Oximeter, and ResScan 3.5 software. Respironic EverFlo OPI Oxygen Concentrator 3 lpm
EEP 9.0, min PS 6.0, max PS 16.0, FitLife Mask

White Beard,

You're absolutely right! I forgot about conscious sedation. If you know you have sleep apnea, and especially if you've had problems waking up in the past, then it's a good idea to tell your doctor about it. For a colonoscopy, using your xPAP is probably a good idea. I'm not sure how you can use it for upper endoscopy :)   (most upper endoscopies are done with just topical anesthesia anyway)

Unfortunately, hospitals are not very amenable to patients bringing their own xPAP machines, let alone use it even if the patient brings it.

As you can imagine, many cases of severe sleep apnea are first noticed during conscious sedation procedures due to the loud snoring and drops in oxygen sats.

One way of dealing with conscious sedation if you don't have an xPAP machine is to place an oral airway or a nasal trumpet. These instruments bypass the tongue obstruction and you can be ventilated easily using a mask if necessary. Are they doing it in the doctor's office or in a hospital setting. For certain situations (such as yours), it may be safer to do it in a hospital. Thanks for sharing. Good luck and keep us posted.


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Steven Y. Park, M.D.
http://www.doctorstevenpark.com

before my sleep apnea was diagnosed, I underwent a generel anasthetic for a cysterscope and later was sedated for eye surgery and eventually fell asleep during it

in both cases my severe cronic fatigue meant the apnea was present  and my mormal loud smoring with obvious apneas would have been heard by all, but it never occurred to anyone that I might have had a sleep disorder   the eventual diagnosis and sleep study was still years ahead

seems to me that the sleep disorder docs need to educate the anasthetic docs about what to watch and listen for


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resmed S6 lightweight, respironics comfort gell mask using CPAP since 1995, no humidifier
during my many years of undiagnosed severe fatigue, no doctor ever asked me if I snored

WhiteBear, you have to have someone drive you, right? So have your "driver" bring your VPAP. Family is allowed to come into the "recovery" area, have your driver put your mask on you and turn your VPAP on. Inform the nursing staff that your family member is to be brought into "recovery" immediately and why. In fact, you might want to put this in written form and see to it that is part of your medical record at the time of the scope.


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Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

I am having a colonoscopy day after tomorrow. This is my fourth and I did not have a CPAP for any of them. They said to bring the machine but i don't want to based on somethings said here. I thought maybe the nurses wouldn't know how to use it or they would fiddle with the settings. I'd have to bring distilled water etc. They hook me up to oxygen. Wouldn't that be enough? I don't know why I'm nervous about the CPap. it's really uncomfortable and i'm afraid of waking up during the procedure.

I do not understand why you would not bring your CPAP?  Did you read the ASAA flyers?  They have distilled water, you don't have to bring it.  They do not know how to fiddle with the settings.  All you have to do is put your mask on and start it yourself before they start the procedure.  It is highly unlikely you will wake up during the procedure.  I had two colonoscopies conscious, granted my unconscious one was nicer, but even should you come out of sedation a little, conscious was still quite bearable.

Oxygen won't help you if your throat is collasped and it can't even get there.  Using your CPAP truly is not a big deal.  

Vicki


_________________
Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Von Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

I guess it would be hard to understand why I wouldn't bring it because you are informed. I am new to this and it is all a mystery and everything about apnea and cpap is big deal to me. As yet I have not even seen or spoken with the sleep doctor who DX the apnea from my sleep study even tough I have been on CPAP two months. Thanks for the info. I will bring it and use it.

isigh,

If you have some specific concerns, post them and I will help you.  Read those links at the beginning because they will help to take a great deal of mystery out of it.

It is not acceptable that you haven't seen your doctor for a followup visit.  I would suggest that you find someone who is more involved in your care.  You can find an accredited sleep doc. by calling the American Board of Medical Specialties at www.abms.org.  We recommend you find someone who is accredited in sleep medicine and you will work with you as a partner in your care.

Our purpose here is to educate so that it isn't overwhelming so keep posting your questions!  I feel for you with the colonoscopy prep too!

Vicki


_________________
Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Von Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

Thanks Vicki. That is very comforting to know. I know it is not right I haven't sen the sleep therapist. They do not have enough sleep docs at the clinic to see all the patients. My primary had to push through to get my study done and I was greatfull for that. I'm only a few miles from Stanford but I wanted to go to the clinic that has my cancer treatment. Right now I am in the middle of all my tests and scans and I think my docs see the cancer as the main concern. But this forum has taught me a lot. If I don't get the apnea under control, I don't have as good a chance of surviving the cancer. I am sleeping six hours now. That is a really good thing. I just have the normal stuff I hear here. My face looks like someone beat me up in the morning and the bridge of my nose is bruised. But I am less tired in the day time. My biggest challange is to lose weight. I think my apnea went away when I was on chemo. I was 45 pounds thinner. Thanks so much for your concern. I can't even think of questions now. But I will stay in contact with this group!

It isn't even during the scope so much that you need your CPAP as it is afterwards in recovery. You are constantly being monitored during the colonoscopy. BUT - AFTER - the scope they only check on you occasionally as the sedation wears off and THAT is when you are in the greatest danger. The same holds true after surgery w/general anesthesia - it is in the recovery room where you are NOT being monitored CONSTANTLY as you are in the operating room that you are at greatest risk w/o your CPAP.


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Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.