Obstructive sleep apnea (OSA) is characterized by cyclical upper airway collapse, hypoxia, arousal from sleep, and is associated with sympathetic discharge, endothelial dysfunction, and hypercoagulability (1). Severe, untreated OSA is associated with adverse cardiovascular (CV) events, and is under-diagnosed in the community (2). The prevalence of OSA in surgical populations is high, and current anesthetic guidelines recommend preoperative screening for OSA (3). In the postoperative period, the combined effects of anesthesia, sedation and analgesia conspire to exacerbate pre-existing OSA. What is less clearly understood is the effect of OSA on postoperative outcomes, with previous analyses of large databases showing conflicting results (4-6).