The Society of Anesthesia and Sleep Medicine: A New Collaboration

While mankind has always shown interest in sleep and dreaming, it has been the scientific study of sleep over the last 3 centuries that has established the roots of modern sleep medicine. From the first descriptions of circadian rhythms in the late 1700s, to the discovery of REM sleep in the 1950s, to the establishment of the first sleep disorders clinics to manage patients with narcolepsy and insomnia in the 1970s, sleep medicine has evolved into a multidisciplinary field responsible for the evaluation and management of over 90 recognized sleep disorders. Given the breadth of pathophysiology that has been associated with sleep, practitioners of sleep medicine come from a variety of backgrounds but share a common interest in sleep and sleep disorders. The field of anesthesiology is now added to the growing list of specialties with a vested interest in sleep medicine.

As early as 1985, descriptions of significant episodic hypoxia during sleep associated with the use of IV narcotics following major surgery under general anesthesia were reported (Catley et al. Anesthesiology. 1985;63[1]:20). Subsequent studies by anesthesiologists examined the effects of general anesthesia on airway collapse (Nandi et al. Br J Anaesth. 1991;66[2]:153) and sleep architecture (Knill et al. Anesthesiology. 1990:73[1];52), offering potential explanations for the intermittent hypoxia found postoperatively during sleep. These reports prompted others to take a closer look at patients with obstructive sleep apnea (OSA) undergoing general anesthesia and postoperative analgesia. Case series emerged suggesting patients with OSA were at risk for a variety of adverse postoperative outcomes (Rennotte et al. Chest. 1995;107[2]:367; Ostermeier et al. Anesth Analg. 1997;85[2]:452), but this was not confirmed until well-controlled studies were performed (Mooe et al. Coron Artery Dis. 1996;7[6]:475; Gupta et al. Mayo Clin Proc. 2001;76[9]:897). In addition to postoperative concerns, data began to emerge regarding intraoperative management problems in patients with OSA (Siyam and Benhamo. Anesth Analg. 2002;95[4]:1098). As a result of these findings, both the American Academy of Sleep Medicine and the American Society of Anesthesiology (ASA) published reviews on the topic of the perioperative management of patients with OSA, recognizing that much is unknown (Meoli et al. Sleep. 2003;26[8]:1060; Gross et al. Anesthesiology. 2006;104[5]:1081). The issues related to surgery and sleep apnea are quite broad, ranging from preoperative screening to intraoperative management to postoperative monitoring and management. These were recently reviewed in the Sleep Strategies section in CHEST physician last November (Auckley and Bolden. CHEST Physician. 2010; 5[11]:13), as well as in a recent extensive review article (Seet and Chung. Can J Anaesth. 2010; 57[9]:849).

Due to the complex and interdisciplinary nature of OSA in the perioperative setting, it is clear that collaborations are required in order to make significant progress in education and knowledge about this issue. As such, a group of anesthesiologists, sleep physicians, surgeons, emergency physicians, and basic scientists with an interest in sleep and anesthesia organized a symposium on this topic prior to the annual meeting of the American Society of Anesthesiologists (ASA) in October 2010. Out of this symposium emerged the formation of the “Society of Anesthesia and Sleep Medicine (SASM),” whose purpose is to promote discussion, education, development of clinical standards, and research related to issues common to anesthesia and sleep.

The SASM objectives are to:
•Promote the cross-fertilization of ideas between anesthesiology and sleep medicine.
•Stimulate research aiming to better understand the similarities and differences between sleep and anesthesia, as well as their impact on physiologic control systems.
•Encourage clinical and epidemiologic studies determining the associations between sleep-disordered breathing and perioperative risk.
•Examine methods of minimizing perioperative risk of upper airway obstruction or ventilatory insufficiency in predisposed individuals.
•Explore the use of noninvasive positive airway pressure therapies to prevent and treat perioperative upper airway obstruction or hypoventilation.

As stated in the first two objectives, the intersection of anesthesiology and sleep medicine is much broader than just sleep-disordered breathing in the perioperative setting. Fostering collaborations between these two disciplines should give rise to a better understanding of the physiology and pathophysiology of the sleep/wake states, the impact of medications and medical interventions on these states, and potentially new and safer forms of anesthesia, as well as novel therapies for sleep disorders. Recognizing the extensive overlap in the basic science and anatomic, physiologic, and clinical realms of anesthesiology and sleep medicine, the America Board of Medical Specialties has recently announced the availability of subspecialty certification in Sleep Medicine to anesthesiologists. This requires that the anesthesiologist be board-certified in anesthesiology and either complete a 1-year ACGME-certified sleep fellowship training program, or have the equivalence of 12 months of practice experience in sleep medicine (to include a minimum of 400 patient evaluations, 200 polysomnogram interpretations, and 25 multiple sleep latency interpretations). More details regarding the pathways for anesthesiologists to achieve sleep medicine board certification can be found at the American Board of Anesthesiology Web site (www.theaba.org).

The SASM has established a steering committee, and the society is now incorporated and taking applications for membership. Interested individuals can contact Dr. Norman Bolden at nbolden@metrohealth.org. For further information, visit the SASM Web site (www.anesthesiaandsleep.org).

The SASM is also organizing its first annual conference to be held on October 14, 2011, just prior to the start of the annual ASA meeting in Chicago. The objectives of the inaugural meeting are to provide a forum for discussions regarding the common areas of OSA, sleep, and anesthesia, and to promote excellence in medical care, research, and education in sleep medicine, anesthesiology, and perioperative medicine. The meeting will include the election of board members, presentations of basic science and clinical research abstracts (deadline was June 30, 2011), and three sessions with invited speakers. The sessions scheduled for this inaugural meeting include:
•Session 1 - “Unconsciousness and the Upper Airway - Shared Considerations for Anesthesiology and Sleep Medicine”
•Session 2 - “Obstructive Sleep Apnea - A Perioperative Challenge”
•Session 3 - “Sleep, Anesthesia, and Ventilatory Control”

This is an exciting time for a new partnership between anesthesiology and sleep medicine. A companion announcement of this collaboration is currently being published in the anesthesia literature (Chung et al. Anesthesiology. 2011;114[6]:1261), and all those with an interest in this field are encouraged to become involved with the new society.

Dr. Dennis Auckley, FCCP
Division of Pulmonary, Critical Care,
and Sleep Medicine; and
Dr. Norman Bolden
Department of Anesthesiology
MetroHealth Medical Center
Case Western Reserve University,
Cleveland, OH

Dr. Frances Chung
Department of Anesthesiology
Toronto Western Hospital,
University of Toronto,
Toronto, ON, Canada

Dr. David Hillman
Department of Pulmonary Physiology
Sir Charles Gairdner Hospital
Perth, Western Australia

Dr. Ralph Lydic
Department of Anesthesiology
University of Michigan,
Ann Arbor, MI