A close relationship exists among OSA, sleep, and anesthesia. Upper airway behavior during sleep serves to some extent as a surrogate of airway behavior during anesthesia and recovery from anesthesia. Likewise, upper airway abnormalities observed by anesthesiologists during the perioperative period is likely to predict upper airway behavior during sleep. A patient with an upper airway that is prone to collapse may also be at increased risk of compromised arousal mechanism in the postoperative period. Several large database studies and two meta-analysis have shown that patients with OSA have increased risk of postoperative complications.,,,,,,, Two recent meta-analysis of 13 and 17 studies indicate that, compared with patients with OSA, patients with OSA have a higher incidence of respiratory complications, postoperative cardiac events, and increased ICU transfer., In line with the meta-analysis, five recent studies using data from large national and international databases including millions of patients demonstrated a significantly increased risk of atrial fibrillation, respiratory failure, aspiration pneumonia, ARDS, increased emergent postoperative endotracheal intubation, and need for postoperative ventilation among patients with a diagnosis of OSA vs control subjects.,,,,, D’Apuzzo et al demonstrated that there is increased mortality in OSA vs patients without OSA undergoing revision joint arthroplasty (OR, 1.9; P = .002). That this study included patients undergoing revision arthroplasty may suggest a higher burden of comorbidities. Paradoxically, the increased risk of cardiopulmonary complications did not translate into increased risk of in-hospital mortality in two studies., There may be several reasons behind the reduction in in-hospital mortality: (1) patients with OSA may have received more vigilant care; (2) patients with OSA may have exhibited signs of deterioration earlier in their hospital course; (3) the reason behind respiratory failure in patients with OSA may have been easier to treat (eg, respiratory failure from upper airway compromise vs aspiration pneumonia or ARDS); or (4) in the control group, patients may have undiagnosed OSA with increased risk of mortality and morbidity. Indeed, in two studies of postsurgical patients,, those with an OSA diagnosis who developed respiratory failure were intubated earlier and received mechanical ventilation for a shorter period, suggesting that the cause of respiratory failure was rapidly reversible, perhaps related to upper airway complications resulting from sedatives and opioid analgesics.