Activity Description
Patients with obstructive sleep apnea may present significant problems in the perioperative period, including difficult airways, sensitivity to anesthetic agents, and postoperative adverse events. This eight page monograph is an assimilation of material presented at the Challenges in the Perioperative Management of OSA Patients symposium, held in October of 2010, and is designed to provide practical solutions and strategies for the perioperative care of patients with OSA. Additional contributions have been made by course faculty, and references to recent publications regarding OSA practice guidelines have been included.

Target Audience
This activity is designed for anesthesiologists, surgeons, physicians, nurse practitioners, certified nurse anesthetists, anesthesia assistants, respiratory therapists, and other healthcare providers interested in the perioperative care of patients with obstructive sleep apnea.

Method of Participation
The estimated time to complete this activity is 1.5 hours. To obtain credit, participants should  take the online pretest, read the monograph, answer the multiple-choice posttest questions, and complete the evaluation form online to receive a certificate online immediately upon completion. Adobe Reader is required to view this monograph, and can be downloaded at http://get.adobe.com/reader/.

Educational Objectives

Following completion of this educational activity, learners should be able to:

• Review the pathophysiology of OSA in the context of recent clinical research regarding perioperative care, sleep, and anesthesia.
• Determine the challenging link between comorbidities, including obesity, and their effects on airway management and ventilation.
• Formulate how to implement screening and treatment procedures for obstructive sleep apnea.
• Discuss the preoperative, intraoperative, and postoperative risks to patients with OSA, and apply strategies to mitigate these risks in support of positive patient outcomes.


Statement of Need
Obstructive sleep apnea (OSA) is the most prevalent sleep disorder in the adult population. Current estimates suggest that moderately severe OSA is present in approximately 11.4% of men and 4.7% of women. The prevalence of OSA is higher in patients presenting for surgery than in the general population, and a significant proportion of OSA patients remain undiagnosed when they present for surgery. This is of concern to the perioperative physician, as OSA has been associated with increased perioperative risk and postoperative complications.

Accreditation

The University of California, San Diego School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation

AMA: The University of California, San Diego School of Medicine designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

BRN: For the purpose of recertification, the American Nurses Credentialing Center accepts AMA PRA Category 1 Credits™ issued by organizations accredited by the ACCME. For the purpose of relicensure, the California Board of Registered Nursing accepts AMA PRA Category 1 Credits™ (report up to 1.5 hours of credit and list “CME Category 1” as the provider number).

This activity was planned in collaboration with the University of Toronto.

Release Date: April 26, 2011
Expiration Date: April 25, 2014


Course Co-Directors

Frances Chung, MBBS
Professor, Department of Anesthesia
Medical Director, Combined Surgical Unit
and Ambulatory Surgical Unit
University Health Network
University of Toronto
Toronto, Ontario, Canada

Terence M. Davidson, MD
Professor of Surgery, Head and Neck Surgery
Associate Dean, Continuing Medical Education
University of California, San Diego School of Medicine
San Diego, California, USA


Faculty

Jonathan L. Benumof, MD
Professor
Department of Anesthesiology
University of California, San Diego
San Diego, California, USA

Daniel Davis, MD
Professor of Clinical Medicine
Department of Emergency Medicine
Director, UCSD Center for Resuscitation Science
University of California, San Diego
San Diego, California, USA

Thomas Ebert, MD
Professor and Program Director
Department of Anesthesiology
Medical College of Wisconsin
Staff Anesthesiologist
VA Medical Center
Milwaukee, Wisconsin, USA

Matthias Eikermann, MD
Staff Intensivist and Anesthesiologist
Department of Anesthesia, Critical Care and Pain Medicine
Massachusetts General Hospital
Assistant Professor of Anesthesia
Harvard Medical School
Boston, Massachusetts, USA

Peter C. Gay, MD
Professor of Sleep Medicine
Mayo Clinic
Rochester, Minnesota, USA

David Hillman, MBBS, FANZCA, FRCP(Edin), FRACP(Hon)
Head, Department of Pulmonary Physiology
Director, West Australian Sleep Disorders Research Institute
Sir Charles Gairdner Hospital
Perth, Australia

Shiroh Isono, MD
Associate Professor, Department of Anesthesiology
Graduate School of Medicine
Chiba University
Chiba, Japan


Frank Overdyk, MD
Professor of Anesthesiology
Medical University of South Carolina
Charleston, South Carolina, USA


Editors

Angela Felker, MA
University of California, San Diego
Continuing Medical Education
San Diego, California, USA

Christina Williams
University of California, San Diego
Continuing Medical Education
San Diego, California, USA


Balance and Objectivity of Content
It is the policy of the University of California, San Diego School of Medicine to ensure balance, independence, objectivity and scientific rigor. All persons involved in the selection, development and presentation of content are required to disclose any real or apparent conflicts of interest. All conflicts of interest will be resolved prior to an educational activity being delivered to learners through one of the following mechanisms 1) altering the financial relationship with the commercial interest, 2) altering the individual’s control over CME content about the products or services of the commercial interest, and/or 3) validating the activity content through independent peer review. All persons are also required to disclose any discussions of off label/unapproved uses of drugs or devices. Persons who refuse or fail to disclose are disqualified from participating in the CME activity. Participants will be asked to evaluate whether the speaker’s outside interests reflect a possible bias in the planning or presentation of the activity. This information is used to plan future activities.


Disclosure

The faculty have reported the following relevant financial relationships:

Frances Chung, MBBS: Research grants from the ResMed Foundation and the Respironic Foundation
Terence Davidson, MD: Member of the ResMed Foundation Board. Current work supported by an unrestricted grant from ResMed.
David Hillman, MBBS: Consultant for ResMed and Apnex Medical
Frank Overdyk, MD: Honorarium Recipient and Consultant for Covidien; Honorarium Recipient from CareFusion.

The following faculty indicated they have no financial relationships with commercial interests relevant to the content of this activity.

Jonathan Benumof, MD
Daniel Davis, MD
Thomas Ebert, MD
Matthias Eikermann, MD
Peter Gay, MD
Shiroh Isono, MD

The CME staff, meeting planners, editorial staff, planning committee, and CME committee reviewers do not have any relevant financial relationships to disclose.

Off-label Disclosure: This educational activity may contain discussion of unlabeled and/or investigational uses of agents that are not approved by the FDA. Please consult the prescribing information for each product.

The views and opinions expressed in this activity are those of the faculty and do not necessarily reflect the views of the University of California, San Diego.


Cultural Competency
This activity is in compliance with California Assembly Bill 1195 which requires CME courses with patient care components to include curriculum in the subjects of cultural and linguistic competencies. Cultural competency is defined as a set of integrated attitudes, knowledge, and skills that enables health care professionals or organizations to care effectively for patients from diverse cultures, groups, and communities. Linguistic competency is defined as the ability of a physician or surgeon to provide patients who do not speak English or who have limited ability to speak English, direct communication in the patient’s primary language. Cultural and Linguistic Competency was incorporated into the planning of this activity. Additional resources on cultural and linguistic competency and information about AB1195 can be found on the UC San Diego CME website at http://cme.ucsd.edu.

Acknowledgment

This activity was supported by educational grants provided by Phillips Respironics and ResMed.