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How Dangerous Is Obstructive Sleep Apnea During Surgery?


Shakespeare, on the whole, was in favor of sleep – at least if the opinions of his characters are any guide to his own opinion. "He that sleeps feels not the toothache," says the Gaoler in Cymbeline. Sleep, says Macbeth:

… knits up the ravell’d sleave of care

and is:

The death of each day’s life, sore labour’s bath,

Balm of hurt minds, great nature’s second course,

Chief nourisher in life’s feast.

By contrast, not to sleep is a torment. Shakespeare must have known insomnia, for in Sonnet XXVII he says:

Weary with toil, I haste me to my bed…

But then begins the journey in my head…

And keeps my drooping eyelids open wide,

Looking on darkness which the blind do see.

Shakespeare also knew that “there’s meaning in thy snores,” though perhaps not the meaning that doctors now attach to them. They often mean obstructive sleep apnea (OSA), when sleep, which should be "death’s counterfeit," becomes death’s possible harbinger, in the form of heart attacks and strokes.

According to a recent article in the New England Journal of Medicine, between a fifth and a quarter of the American population suffer from OSA, and this poses a risk, whose magnitude is not precisely known, to patients undergoing surgical procedures. The reason the magnitude is not precisely known is that it is difficult to control for obesity: not all people who are fat have OSA, and not all people who have OSA are fat, but there is a strong correlation, almost certainly a causative one. What the authors of the article call "the epidemic" of OSA – yet another epidemic of a non-contagious risk factor – is really an "epidemic" of obesity. A higher proportion of patients undergoing surgery than in the rest of the population have OSA: not surprisingly, 80 percent of patients being operated on for their obesity have it. All in all, perhaps 10 million operations are performed in America annually on people with OSA.