Obstructive sleep apnea endotypes and their postoperative relevance

Obstructive sleep apnea (OSA), characterized by repetitive upper airway collapse during sleep, is estimated to affect nearly 1 billion people worldwide. OSA is a common comorbidity in people undergoing surgical procedures, with rates as high as 91% in those undergoing bariatric surgery. OSA is an important risk factor for adverse postoperative outcomes including cardiac complications, opioid-induced ventilatory depression, and unplanned intensive care unit transfers. Given these risks, preoperative identification of people with OSA is recommended by society guidelines.

Recent advances in the understanding of the mechanisms that lead to OSA have identified four key pathophysiological traits or OSA endotypes. The term pathophysiological phenotypes has also been used interchangeably in the literature to describe the different underlying mechanisms that contribute to OSA pathogenesis. However, the term phenotype can also encompass the different clinical manifestations and consequences of the disease. Thus, endotype is a technically more appropriate term to describe the underlying mechanisms of disease and is therefore used throughout this review.