Call to Prevent Post-Operative Deaths in OSA Patients


Obstructive Sleep Apnea Death and Near Miss Registry


Following the reporting of a number of postoperative cardiopulmonary arrests and deaths among patients with obstructive sleep apnea (OSA) in the late 1990s and early 2000s, {1}, {2}, {3} the American Academy of Sleep Medicine and American Society of Anesthesiologists published guidelines for monitoring of patients with OSA following surgery {4}, {5}.


In recent years while adverse outcomes in OSA patients following surgery have been documented, there have been very few reports of postoperative deaths in this cohort of patients. Does this mean that such events are no longer newsworthy? Or is it fair to assume that postoperative deaths in the OSA patient population are no longer a problem?


Far from it.


At an informal gathering following the 2011 SASM (Society of Anesthesia and Sleep Medicine – {6}) annual conference, medical practitioners expressed strong concern on the lack of awareness of continuing occurrence of unexpected post-operative deaths in OSA patients – ‘Dead in Bed’ cases as they are termed.


As a result, the SASM Board set up the “Dead in Bed” Registry Committee with Dr. Norman Bolden as its chair. Deliberations by the SASM “Dead in Bed” Committee revealed that in many cases patients did not die but were left with devastating neurologic injury or found in cardiopulmonary arrest, from which they could be successfully resuscitated. Much was learnt from both deaths and near misses, and the name of the Registry was subsequently changed to the ‘OSA Death and Near Miss Registry’.{7}


The SASM has since partnered with the Anesthesia Quality Institute (AQI) to use data from the Anesthesia Closed Claims Project and its Registries to advance the OSA Death and Near Miss Registry. It hopes to collect a large number of detailed case reports and identify the following factors associated with OSA-related adverse postoperative events for analysis

  • Levels of monitoring exercised in cases of deaths or near misses
  • Reasons for such adverse events and what can be done to limit them
  • Best practices for care of patients with OSA during the perioperative period


Patients of age 18 or more, diagnosed or suspected of OSA and involved in one of the following outcomes qualify for inclusion to the registry for OSA-related adverse event

  1. Death
  2. Brain injury
  3. Urgent or emergent transfer within 30 days of surgery to ICU for respiratory distress, respiratory arrest, Code Blue or ACLS protocol


To submit anonymous cases or obtain more information about the OSA Death and Near Miss Registry, please go to www.asaclosed- and click on the tab for projects. Specific questions about the registry can be forwarded to Karen Posner, PhD, Department of Anesthesiology & Pain Medicine, University of Washington Retrospective cases that occurred in 1993 or later may also be submitted. 


Source: Society of Anesthesia and Sleep Medicine



{1} – Ostermeier AM, Roizen MF, Hautkappe M, Klock AP, Klafta JM. Three Sudden Postoperative Respiratory Arrests Associated with Epidural Opioids in Patients with Sleep Apnea. Anesth Analg 1997;85:452-60


{2} – Lofsky A. Sleep Apnea and Narcotic Postoperative Pain Medication: A Morbidity and Mortality Risk. APSF Newsletter 2002;17:24-25


{3} Bolden N, Smith CE, Auckley D. Avoiding Adverse Outcomes In Patients With Obstructive Sleep Apnea: Development and Implementation of a Perioperative OSA Protocol. Journal of Clinical Anesthesia. 2009; 21:286-93


{4} Meoli AL, Rosen CL, Kristo D, Kohrman M, Gooneratne N, Aguillard RN, Fayle R, Troell R, Kramer R, Casey KR, Coleman J Jr. Clinical Practice Review Committee American Academy of Sleep Medicine. Upper airway management of the adult patient with obstructive sleep apnea in the perioperative period-avoiding complications. Sleep 2003; 26:1060-5


{5} Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 2014;120(2):268-86


{6} Chung F, David Hillman D, Lydic R. Sleep Medicine and Anesthesia – A New Horizon for Anesthesiologists. Anesthesiology 2011; 114:1261-2


{7} Society of Anesthesia and Sleep Medicine (SASM) Obstructive Sleep Apnea Death and Near Miss Registry Committee: Norman Bolden MD (Chair), Dennis Auckley MD, Kenneth L. Bachenberg MD, Jonathan Benumof MD, Frances Chung MBBS, David Hillman MD, Frank Overdyk MD, Satya Krishna Ramachandran MD, David Samuels MD, Anesthesia Quality Institute: Karen Domino MD, MPH , Karen L. Posner PhD

Related Posts