Patients with obstructive sleep apnea (OSA) have an increased rate of postoperative complications1,2  and, accordingly, ASA guidelines recommend they receive more intense postoperative monitoring. OSA is the most common sleep breathing disorder in adults, with an estimated prevalence of 17 percent and 9 percent among middle-aged men and women, respectively. It is worrisome that up to 90 percent of patients with OSA are undiagnosed, and up to 20 percent of surgical patients are at risk for having unrecognized OSA. Therefore, it is of the utmost importance to identify patients for adverse perioperative respiratory events. However, both surgeons and physician anesthesiologists do poorly at recognizing preexisting OSA or those at risk for OSA during routine evaluation.6,7 

Traditional phase I postanesthesia care unit (PACU) discharge criteria assesses postanesthesia respiratory recovery by the...

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