0658 Total Intravenous Anesthesia versus Inhaled Anesthetics in Patients with Obstructive Sleep Apnea: A Systematic Review

Abstract Introduction Obstructive Sleep Apnea (OSA) increases the risk of perioperative respiratory and cardiovascular complications, making anesthetic selection crucial for patient safety. Both total intravenous anesthesia (TIVA) and inhalational anesthesia are used in patients with OSA, but their perioperative outcomes remain uncertain. This systematic review aimed to evaluate the efficacy and safety of TIVA compared with inhalational anesthesia for patients with OSA. Methods Following PRISMA 2020 guidelines, a comprehensive search was performed across PubMed, MEDLINE, Web of Science, CINAHL, Cochrane Library, and Google Scholar through October 2025. Primary outcomes were postoperative respiratory complications. Secondary outcomes included extubation time, post-anesthesia care unit (PACU) length of stay, postoperative nausea and vomiting (PONV), and 30-day morbidity or mortality. Meta-analysis was intended to be conducted using R software under a random-effects model, and the risk of bias was assessed using RoB 2.0 and ROBINS-I tools. Results A total of 266 records were identified through database searches. After screening and eligibility assessment, four studies met inclusion criteria, encompassing 631 participants in total. All studies were conducted between 2019 and 2020 at a single tertiary academic center in the United States. Because all eligible studies were conducted at the same institution and time frame, involving potentially overlapping patient populations, a quantitative meta-analysis was not performed to avoid double counting. Instead, findings were synthesized qualitatively. The studies included one randomized controlled trial and three retrospective comparative cohort studies. Across studies, mean age ranged 55.4 ± 12.1 to 56.2 ± 12.4 years and BMI from 29.7 ± 4.3 to 29.8 ± 3.6 kg/m2. Overall, 75% of the studies reported a significant reduction in Phase I or total recovery time with total intravenous anesthesia (TIVA) compared with inhalational anesthesia, while one study (25%) found no statistically significant difference. No other significant differences were found. Conclusion TIVA provides comparable safety and faster postoperative recovery than inhalational anesthesia in adults with OSA, without increasing respiratory complications or PONV. These findings support TIVA as a viable anesthetic approach for OSA patients, particularly in upper airway surgeries where postoperative airway control is critical. Further randomized trials with standardized outcomes are warranted to confirm the results and strengthen recommendations. Support (if any)