Question:
Want to speak to people who had WLS sleep apnea that was treated with CPAP
Could you let me know, please? I'm a little freaked over this poor lady, Ginger Brewster, who was not tested prior to surgery and stopped breathing as a result of not being treated for sleep apnea and the morphine. I do use a CPAP and know that my surgeon's nurse says they use my machine at the hospital but they don't place you in ICU UNLESS something goes bad. So I COULD stop breathing and no one would know???? Yikes! Need some people in similar circumstances to get some reassurance. Thanks!!! Nelly — Nell C. (posted on August 1, 2002)
August 1, 2002
ALL my surgeons sleep apnea patients get put on a monitored bed with
cardiac and pulse OX monitor. Its like a step down unit, not quite
intensive care but careful monitoring. My pressure was 17 and I had no
problems.<P> I personally wouldnt use a surgeon who didnt provide a
monitored bed after surgery. In the terribly sad case were discussing his
malpractice insurance is going to take a big hit. Sadly that doesnt bring
her back. ALL SURGEONS SHOULD KNOW BETTER! I had a bad time after minor
knee surgery and nearly died, at that point they didnt know I had sleep
apnea... Bad they had to give me narcam the anti narcotic, it helped my
breathing but I was in lots of pain. <P> Surgery is SAFE with proper
precautions. I would speak to my surgeon...
— bob-haller
August 1, 2002
Nell, make sure you bring your CPAP to the hospital with you the day of
surgery. Whoever is coming with you should know how to set it up and do so
when you get to your room. (This ususually just involves plugging it in
and maybe getting respiratory therapy to bring water for your humidifier.)
My surgeon will not give apnea patients morphine. Make sure you discuss
this with your surgeon before surgery. Also your companion should know
this in case someone tries to give you morphine while your still out of it.
They pain is not excessive from the surgery and you should be up and awake
in just a few hours. Don't be afraid to be your own advocate. When you
want to sleep put on your CPAP or call for help to get it on. Don't worry
about sleeping in the recovery room, you're closely monitored there. Good
luck.
— Janis D.
August 1, 2002
Thanks, guys, for answering. I am so glad I read the post about Ms.
Brewster! I would never have thought of all this. I will be sure to check
with the nurse this week about how I will be cared for and to make sure I'm
not given morphine. Found an interesting article that backs up all this:
FEATURES
Complications in Postoperative Patients with Sleep Apnea
Source: Mayo Clinic
09/12/2001
ROCHESTER, MINN. -- Patients with obstructive sleep apnea syndrome
experienced a greater number of serious medical complications following
elective knee or hip replacement surgery than patients without the
syndrome, Mayo Clinic researchers report.
Adverse postoperative outcomes occurred in 24 percent of the patients with
obstructive sleep apnea syndrome compared with nine percent of the patients
in the study's control group who did not have the syndrome. The study
matched 101 patients with obstructive sleep apnea syndrome with 101
patients without it.
The study is published in the September issue of Mayo Clinic Proceedings.
Authors of the study are: Rakesh M. Gupta, M.D., now of the Sleep Disorders
Center, Roger Williams Medical Center, Providence, R.I.; Javad Parvizi,
M.D.; Arlen D. Hanssen, M.D.; and Peter C. Gay, M.D. Drs. Parvizi, Hanssen
and Gay are all with Mayo Clinic.
"Although we intuitively had concerns that obstructive sleep apnea
patients undergoing surgery were at increased risk of complications, there
is very little information about this," says Dr. Gay, the senior
investigator in the study. "We are particularly anxious to bring these
findings to the attention of both physicians and patients alike as the
possibility of increased risk from sleep apnea during elective surgery is
not often aggressively pursued. The next study we wish to pursue is to show
that the evaluation and treatment of these patients beforehand, can
actually help reduce the increased post-operative risks."
The prevalence of obstructive sleep apnea syndrome is estimated at five to
nine percent and most often affects obese, middle-aged men. More than half
of all cases of sleep apnea are diagnosed in people 40 years of age or
older. The condition also is more common in men than women.
Obstructive sleep apnea occurs when the muscles in the back of the throat
relax. These muscles support the soft palate, uvula, tonsils and tongue.
When the muscles relax, the airway is narrowed or closed and breathing is
momentarily cut off. This lowers the level of oxygen in the blood. The
brain senses this decrease and briefly rouses the person from sleep so that
the airways reopen. This awakening is usually so brief that a person
doesn't remember it. Breathing resumes, possibly with a snort. This pattern
can repeat itself 10 times or more each hour, all night. A person is less
able to reach the deep, restful phases of sleep and often feels sleepy
during waking hours.
In general, only weight loss greater than 10 percent of body weight is
thought to have any impact on symptoms caused by sleep apnea, the authors
report from a previous study.
The authors also reported that the length of hospital stay was
significantly longer for patients with sleep apnea (almost seven days)
versus patients in the control group (five days).
Researchers say the frequency and severity of upper airway obstructions in
patients with obstructive sleep apnea syndrome undergoing joint replacement
are likely to be high for several reasons. First, because of the nature of
the operation, these patients are expected to remain on their back after
the operation. Second, uniform use of moderate amounts of intravenous
narcotics after the operation is likely to precipitate or aggravate the
respiratory complications in patients with obstructive sleep apnea
syndrome.
The study also found that most complications occur in the first 24 hours.
The authors suggest this may be due to the combined effect of the
anesthetic agents, sedatives and narcotics, which tend to relax upper
airway dilator muscles and increase upper airway resistance, thus
aggravating obstructive sleep apnea syndrome.
Mayo Clinic Proceedings is a peer-reviewed and indexed general internal
medicine journal, published for 75 years by Mayo Foundation, with a
circulation of 130,000 nationally and internationally.
— Nell C.
August 1, 2002
My wife spent the night because of my fear over this issue! It was great
having her there! Night 2 she couldnt stay.. had to work... Boy was that
long....!!!!
— bob-haller
August 1, 2002
I would discuss w/your doctor the protocol at your hospital for sleep apnea
patient's who have surgery. My doctor had me bring my cpap machine w/me, it
stayed in my suitcase however as I never needed it and haven't had to use
it in the 7.5 months since my surgery. I was on 3 liters oxygen when I got
to my room from recovery. Got up to pee a few hours later and from then on
I was up and walking w/short naps inbetween. I had morphine for my pain
with out any problems. Everyone reacts to pain meds differently. My doctor
is not a believer in a lot of narcotics because he wants his patient's up
and walking and not knocked out. My dose of morphine was enough to keep the
pain tolerable and still allow me to get up and walk the halls which helps
keep blood clots and pneumonia at bay. Best wishes!!
— jsuggs
August 1, 2002
I had critical sleep apnea. My doc put everyone over a certain BMI or with
some comorbs in ICU. Although I had an oxymeter, and oxygen via canula, as
soon as I could stand, I hooked up my CPAP so I could get some sleep! My
oxy levels stayed OK in theory, but in the tilted bed, I was still snoring
and disturbing myself. What a nuisance. By the way, there is no trace of
the sleep apnea today.
— vitalady
August 1, 2002
Nell....there's no way you could stop breathing without them knowing it
because you'll be hooked up to a monitor. In the recovery room you are
monitored constantly and if your oxygen levels go down, you will either be
given more oxygen or hooked up to your CPAP machine, which is why it is
important to not only have a CPAP machine if you have sleep apnea, but that
you have been using it regularly and tolerting it....AND you bring it with
you the day of surgery.
— Lynette B.
August 2, 2002
I had severe sleep apnea and I, too, worried about being over medicated and
stopping breathing because of the morphine and oxyfast pain med at home.
My surgeon, like most,put me in ICU overnight and there was constant
monitoring. Also the pulse ox is on you at all times. When I got home, I
did worry about this as another patient in WV, died at home from sleep
apnea and over medication. Her name was Carolyn Taylor. I wasn't allowed
to take my CPAP to the hospital and had to use theirs, but I didn't even
use it since I was so closely monitored. As long as the staff KNOWS you
have sleep apnea, they take extra precautions to make sure you are ok.
Just make sure you are diagnosed if you have it. It is worth it to be
reassured about this. I hated my CPAP and didn't use it at all after my
surgery. I did put a small tape recorder by my bed and taped myself many
times. When I had sleep apnea I could hear myself stop snoring for long
periods of time. Then I would gasp and wake up with a loud sigh. It was
really scary to hear. After surgery, I no longer snored or gasped! What a
miracle this surgery is! Now, my hubby, says I am quiet as a mouse when I
sleep.
— Mylou52
August 2, 2002
I found out I had sleep apnea from the consult I had at BTC.
My surgeon suspected I had it and I had to get it checked.
I did have it and had to be on the c-pap for 4 weeks prior to
surgery. I was instructed to bring it to the hospital, which
I did. I was monitored closely the first 24 hours and was
fine. 1 month post op, the c-pap was sent back:) Good Luck!
— M B.
August 5, 2002
Don't worry! I had sleep apnea and have used a CPAP machine since last
Nov. I had surgery on 7/2/02 and brought my CPAP with me, they hooked it up
in recovery and I used it until the day I came home. They were very good
about checking my oxygen levels and I DID have morphine with no problems.
So, make sure that they know about the CPAP, bring it with you, and stop
worrying!
— Jeanne G.
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