Obstructive Sleep Apnea (OSA)

Jean is a 68-year-old female admitted for a total hip replacement. In her interview you learn that she has a history of obstructive sleep apnea (OSA) with a neck circumference of 16 inches and snores much of the night. She is 5’7” and weighs 265 pounds. She states she is sleepy throughout the day. Her other medical history includes: hypertension treated with angiotensin II receptor blockers (ARB), Diabetic with an Hgb A1c over 8%. Hypercholesteremia treated with a Statin drug. Coronary Artery Disease (CAD) with a history of a drug eluting cardiac stent placed 14 months ago and currently on Plavix and ASA. History of gastroesophageal reflux disease (GERD) and is on Prilosec. Her husband has a history of cerebral vascular accident (CVA) several years ago. What medications should she take pre-op and what should she hold? Should Jean be allowed to continue ASA pre-operatively? Should cardiology be consulted on this matter? What are Jean’s risks for diabetes complications? What concerns do you have about her social support system?