ASSESSMENT OF KNOWLEDGE AND PRACTICES REGARDING ANESTHETIC MANAGEMENT OF PATIENTS WITH OBSTRUCTIVE SLEEP APNEA AMONG ANESTHESIA PROFESSIONALS: A NARRATIVE REVIEW

Abstract

Background: Obstructive sleep apnea (OSA) is a highly prevalent sleep-related breathing disorder that substantially increases perioperative risk, including difficult airway management, respiratory depression, hypoxemia, and postoperative cardiopulmonary complications. Anesthesia professionals are central to the preoperative identification, intraoperative management, and postoperative surveillance of patients with known or suspected OSA, yet the international literature repeatedly documents wide variation in relevant knowledge and clinical practice. To narratively synthesize the global, regional (Asian), and national/provincial (Pakistan, with particular attention to Khyber Pakhtunkhwa [KPK]) literature on the knowledge and clinical practices of anesthesia professionals regarding perioperative OSA management, and to present a consolidated, literature-informed picture of current performance across screening, airway assessment, anesthetic technique selection, opioid stewardship, neuromuscular blockade reversal, extubation strategy, postoperative monitoring, and CPAP use. Methods: A structured narrative review was conducted of studies addressing anesthesia professionals' knowledge, attitudes, and practices (KAP) concerning perioperative OSA care, drawing on international, Asian-regional, and Pakistani (including KPK-based) survey and cross-sectional literature. Reported knowledge and practice indicators were qualitatively synthesized and, where comparable across studies, summarized visually. Results: Across the reviewed literature, most anesthesia professionals recognize OSA as an important perioperative risk factor, but a consistent minority display gaps in practical management. Pooled narrative estimates suggest that roughly 55–65% of participants demonstrate adequate overall knowledge, that familiarity with validated screening instruments such as STOP-Bang ranges from approximately 50–65%, and that routine preoperative OSA screening is reported by approximately 60–70% of respondents, with generally lower and more variable figures in Asian and Pakistani/KPK samples than in high-income settings. A majority of professionals favor opioid-sparing analgesia, cautious neuromuscular blockade reversal, awake extubation, and enhanced postoperative respiratory monitoring, but substantial variability persists regarding postoperative disposition, CPAP continuation, and continuous pulse-oximetry monitoring, particularly in resource-limited settings such as KPK. Conclusion: Anesthesia professionals worldwide, in Asia, and in Pakistan generally acknowledge the perioperative importance of OSA, yet gaps remain in systematic screening, use of validated assessment tools, airway management planning, opioid administration, and postoperative monitoring — gaps that appear more pronounced in low-resource settings. Standardized institutional protocols, structured continuing professional education, and simulation-based training in perioperative OSA management are likely to improve consistency of care and patient safety.

Keywords: Obstructive sleep apnea; anesthesia; anesthesiologists; anesthesia professionals; STOP-Bang; perioperative management; airway management; postoperative monitoring; CPAP; Khyber Pakhtunkhwa; Pakistan.