If you’re living with sleep apnea and scheduled for surgery, you may be worried about the effects of anesthesia — the medications used to keep you comfortable, pain-free, and often asleep.

Because anesthesia and some pain medications can relax the muscles that keep your airway open and slow your breathing, sleep apnea may increase the risk of breathing problems, low oxygen levels, or heart-related complications during and after surgery.

Fortunately, you can take steps to lower these risks, such as medication adjustments and closer monitoring during surgery. It’s also important to tell your surgeon and anesthesiologist that you have sleep apnea so they can plan your care.

Here’s what to know about anesthesia’s effects on sleep apnea, the risks, and ways to prepare for surgery.

How Sleep Apnea Affects You Under Anesthesia

With obstructive sleep apnea, the soft tissue at the back of your throat collapses or closes during sleep, causing pauses in breathing. Your body briefly wakes you to restart breathing. Under anesthesia — especially general anesthesia — the medicines used to sedate you reduce this wake-up response.

General anesthesia relaxes the upper airway muscles, slows breathing, and lowers oxygen levels. This can make it harder to breathe after surgery.

Research shows that people with untreated sleep apnea have a higher risk of complications from anesthesia. These problems are usually related to breathing or heart function.

Specific Risks of Anesthesia When You Have Sleep Apnea

If you have sleep apnea, you may have a higher risk of complications with anesthesia. Not everyone will have these problems, but being aware of them can help you ask informed questions about your care. Here are some possible risks:

Challenges During Surgery

It may be harder for an anesthesiologist to perform intubation (place a breathing tube) or help you breathe with a face mask.

Respiratory Issues

You may have more trouble breathing on your own after surgery. This can slow recovery and, in some cases, lead to pneumonia or respiratory failure.

Heart Complications

Sleep apnea can strain your heart over time and raise your risk of heart problems, especially if it isn’t treated. Surgery puts additional stress on your heart and can sometimes trigger a heart attack or stroke. This risk can last up to 30 days after surgery.

Adverse Reactions to Anesthesia

You may be more sensitive to anesthesia. This can lead to low blood pressure, difficulty breathing, or irregular heartbeats. You may also feel confused or disoriented or have temporary memory issues after surgery.

Postoperative Sleep Issues

About three to five days after surgery, some people experience rapid eye movement (REM) sleep rebound, meaning they sleep more or longer. This period may also be linked to a higher risk of heart-related events.

Adverse Reaction to Pain Medications

Pain medications like opioids can slow down your breathing, which raises the risk of breathing problems. Sleep apnea can also make pain feel more intense, so it’s important to use these medications carefully and follow your doctor’s guidance.

How To Prepare for an Upcoming Surgery

If you have a planned surgery — or even an emergency procedure — be sure to tell your surgeon and anesthesiologist that you have sleep apnea. Share your current treatment plan and any relevant medical records. This helps them decide which medications are safest for you, what type of monitoring you’ll need, and how to reduce your risk of complications.

For example, your anesthesiologist may avoid long-acting sedatives or use a type of anesthesia that doesn’t require full unconsciousness, such as a nerve block or spinal anesthesia. They may also provide closer monitoring.

If you use a continuous positive airway pressure (CPAP) device at home, ask if you should bring it to the hospital. Your healthcare team may want you to use it during recovery. They will also give you instructions to follow before surgery and explain what to expect during recovery, both in the hospital and at home.

What To Expect After Your Surgery

Some people with sleep apnea have a higher risk of complications after surgery, so you may want to ask someone to stay with you for a few days. They can help watch for changes in your breathing and get medical help if needed. This is important because people with sleep apnea are more likely to have breathing problems, low oxygen levels, and heart-related issues after surgery.

You should also continue to use your CPAP machine as directed. CPAP can help you breathe better at night and may support your recovery.

One study found that people who continued using CPAP had a 28 percent drop in breathing events and a 56 percent drop in unplanned intensive care unit admissions after general surgery. Among those who had heart surgery, CPAP use lowered heart complications by 37 percent and atrial fibrillation by 41 percent.

Be sure to follow your healthcare provider’s instructions during recovery, including taking medications as prescribed, eating as recommended, and following any other guidance.

It’s also important to watch for side effects of anesthesia, including:

• Nausea
• Vomiting
• Itching
• Sore throat
• Muscle aches
• Chills

Most of the time, these side effects are temporary, but contact your healthcare provider if they become severe or bothersome. Some people may also develop postoperative delirium, which can cause confusion or disorientation after surgery.

If you don’t feel well or if you have concerning symptoms, reach out to your healthcare provider. They can advise you on ways to feel better and keep your recovery on track.

Join the Conversation

On MySleepApneaTeam, people share their experiences with sleep apnea, get advice, and find support from others who understand.

If you have sleep apnea and have had anesthesia, how did you prepare for your procedure? Let others know in the comments below.