Having Surgery? Why Your Surgeon Wants to Know About Your Sleep Apnea

Your surgeon and anesthesia team want to know about sleep apnea. It can raise the risk of heart and breathing problems after surgery. In one large study, some people had severe sleep apnea that had not been diagnosed. They were about twice as likely to have a heart complication (problem) within 30 days of major surgery¹. Checking for sleep apnea before surgery helps the team plan extra safety steps.

Why does sleep apnea matter during surgery?

Obstructive sleep apnea (OSA) is a condition where the throat narrows or closes again and again during sleep. This causes pauses in breathing and drops in oxygen. In daily life, OSA that has not been found is linked to higher risk for the heart and blood vessels.

Researchers have asked if the same is true in the days after surgery¹. The studies below suggest that it can be, especially for severe OSA. Many people with sleep apnea do not know they have it. That is why surgical teams ask about snoring, tiredness and other warning signs before an operation.

How risky is undiagnosed sleep apnea before surgery?

A study published in JAMA followed 1,218 adults in eight hospitals across five countries¹. All were having major surgery that was not on the heart. None had been diagnosed with sleep apnea before, but each had a home sleep test before surgery.

The study tracked heart problems in the 30 days after surgery. These included heart injury, heart failure, irregular heartbeat, blood clots or stroke. Heart problems happened in¹:

• Severe sleep apnea — 30% of people
• Moderate sleep apnea — 22% of people
• Mild sleep apnea — 19% of people
• No sleep apnea — 14% of people

The researchers also took other factors into account. After that, only severe sleep apnea was clearly linked to higher risk, about 2.2 times higher¹. People who had complications also spent more time with very low oxygen levels during the first three nights after surgery¹.

A larger 2026 review combined 54 studies with more than 300,000 surgery patients³. People who screened as high risk for sleep apnea had higher odds of breathing and heart complications than low-risk patients. They also stayed in the hospital a bit longer³.

Does using CPAP around surgery lower complications?

CPAP (continuous positive airway pressure) is a machine that blows gentle air through a mask. It holds the airway open during sleep. Doctors measure sleep apnea with the apnea-hypopnea index (AHI). This is the number of breathing pauses or shallow breaths per hour of sleep.

The honest answer is that the evidence is mixed. A review of six studies with 904 surgery patients looked at CPAP around surgery².

• Breathing pauses — CPAP lowered AHI after surgery, from an average of 37 to 12 events per hour².
• Hospital stay — There was a trend toward slightly shorter hospital stays².
• Complications — The number of complications after surgery was not significantly different between people who used CPAP and those who did not².

The 2026 review looked more broadly at safety steps after screening. These included CPAP, visits with a sleep doctor, monitoring plans, wristbands and patient teaching³. High-risk patients who got these steps did not have clearly higher complication rates than the patients they were compared with³. The authors gave a warning. The studies varied widely, and high-quality data are scarce. So these results should be seen as early findings³.

What do the guidelines say about screening?

The Society of Anesthesia and Sleep Medicine made guidelines on checking adults for sleep apnea before surgery⁴. Few strong randomized studies (studies that place people in groups by chance) exist in this area. So most of its advice is based on expert agreement⁴. The guideline asks hospitals to build their own plans, based on each patient's health and the type of surgery⁴.

How can you prepare for surgery if you have sleep apnea?

• Tell your team — Tell your surgeon and anesthesia team if you have sleep apnea. Also tell them if you snore loudly or feel very tired during the day.
• Your machine — If you use CPAP or BiPAP (a similar machine with two pressure levels), ask whether to bring your machine and mask to the hospital.
• Settings and devices — Bring a list of your current machine settings. Also bring any oral appliance (mouth guard) you use.
• Breathing checks — Ask how your breathing will be watched after surgery, especially if you will need pain medicines.

When should you get checked?

Ask about a sleep evaluation before a planned surgery if you:

• Snoring — Snore loudly or have been told you stop breathing in your sleep
• Tiredness — Feel sleepy or tired during the day
• Health risks — Have high blood pressure, obesity or a large neck size
• High-risk score — Were marked as high risk on a sleep apnea questionnaire at a visit before surgery
• Stopped treatment — Have sleep apnea but have not used treatment in a while

Planning ahead gives you and your care team time to test, treat and prepare.

How Universal Sleep Solutions can help

At Universal Sleep Solutions, we offer in-lab and home sleep testing. We also offer CPAP and BiPAP setup and follow-up. We can work with your surgical team when sleep apnea is a concern.

Contact Universal Sleep Solutions to schedule an evaluation.