Danger! Major Surgery - No CPAP Allowed

Major surgery may pose serious and disturbing health risks. For obstructive sleep apnea sufferers among us there may be added risk. Asleep, these individuals often rely upon continuous positive airway pressure for their next life's breath. OSA is the condition whereby the upper air tract relaxes and constricts airflow to the lungs. This impacts dissolved oxygen levels which arouse the sufferer, preventing him from receiving needed sleep. Worse, the afflicted individual may not arouse, occasionally resulting in death.

Transsphenoidal Reintervention (TSR) Pituitary Surgery

One example of a surgery that contraindicates the use of CPAP afterward is transsphenoidal reintervention pituitary surgery. The operation is often performed endoscopically through a small opening at the back of the nose. The author of this article went through such a surgery, and was advised he could not use CPAP for three weeks following surgery. Those who do not use CPAP cannot readily comprehend the fear an OSA patient may feel at being told he cannot use his lifeline. What had to happen to make the surgery a success in this regard?

Pulmonary Evaluation Before Surgery

An appointment was made with Pulmonary. It was decided it was a necessary risk, and that if the pressure was lowered for use after the three-week recovery period, I could proceed with the surgery. Following surgery, an oxygen-moisture mask was strapped on to provide a lightly enriched breathing atmosphere. It ought to be noted that CPAP users following surgery have sometimes been noted to experience a measure of pulmonary edema.

At home, the author has found it best to sleep almost completely vertically upright, to avoid total closure of his airways. A "chair pillow" with an ordinary pillow in front of it made this easy to accomplish. To make up for the lack of noise from his CPAP, an eight-inch personal fan was run in the background to provide sleep-inducing noise. Fortunately, painkillers were not necessary after the surgery, thus not intensifying airway relaxation and collapse.

Three weeks from surgery, the air pressure of the author's CPAP machine may be lowered to a minimal positive pressure setting of 9. Over time that pressure will be restored to its former 12.¹

A Reminder

In preparing for this surgery and doing research on the subject, the author was reminded just how important it is for users of CPAP to faithfully follow the instructions of medical professionals in regularly using the equipment, rather than only employing it on a sporadic basis. The time a sleep apnea sufferer does not use his equipment may be the time when serious consequences result.

Sources and Additional Material:

Personal Experience

Massachusetts General Hospital; The Neuroendocrine Medical Center - Pituitary Tumor Center; "Frequently asked questions about transsphenoidal surgery"
http://pituitary.mgh.harvard.edu/TranssphenoidalSurgery.htm

British Journal of Anaesthesia; "Pituitary Disease and Anaesthesia"
http://bja.oxfordjournals.org/cgi/content/full/85/1/3

¹ Pressures listed here are in "centimeters of water.