Should positive airway pressure be continued uninterrupted after endoscopic skull base surgery? A review of current literature

Obstructive sleep apnea (OSA) poses unique challenges to the perioperative management of endoscopic skull base surgery (ESBS). Currently, no consensus or guidelines exist on the reintroduction of positive airway pressure (PAP) in these patients. To better clarify the safety of PAP reintroduction after ESBS, the databases Pubmed and Embase were searched in May 2024 for studies on PAP reintroduction after ESBS. Two articles, comprising 15 patients, met the inclusion criteria. All patients resumed PAP the first night after surgery. All patients underwent ESBS for transsphenoidal pituitary resection. Only one patient experienced cerebrospinal fluid leak, and no other complications were reported. While these results suggest that early reintroduction of PAP for ESBS patients with OSA may be safer than theoretically expected, the current literature on the topic remains scarce and more research is needed.