Large, retrospective clinical cohorts suggest that preoperative diagnosis of obstructive sleep apnea (OSA) is associated with more than a two-fold increase in the risk for respiratory complications in the immediate postoperative period (i.e., the first 12 hours after surgery).1-6  The contribution of OSA to the causal nature of these complications remains unclear; however, an increased vulnerability of OSA patients to anesthesia- and opioid-induced ventilatory compromise has been proposed as a likely mechanism.7,8 

This hypothesis is supported by experimental and clinical evidence suggesting that chronic intermittent hypoxia, a hallmark phenotype of OSA, may enhance the sensitivity to the analgesic and respiratory-depressant effects of opioids.9-15  Furthermore, retrospective analyses of life-threatening opioid-related respiratory events in the context of postoperative analgesia have shown that obesity, somnolence and OSA diagnosis were common among afflicted patients....

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