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The obstructive sleep apnea (OSA) patient presenting for OSA surgery presents a number of challenges to the anesthesiologist. OSA is diagnosed by clinical history and an overnight sleep study or polysomnography (PSG). PAP treatment attempts to maintain a competent airway through the application of continuous positive airway pressure (CPAP), bi-level positive pressure (BiPAP) or auto-titrating positive pressure (APAP). The three anatomic areas that can contribute to OSA as a result of increased nasal resistance include the alar cartilage/nasal valve area, the septum and the turbinates. These patients may have a number of cardiac and respiratory comorbidities as well as very challenging airways. Consideration should be given to optimization of medical comorbidities preoperatively, careful airway management, and minimization of sedating pain medications intraoperatively. Postoperatively airway edema, hemorrhage, and respiratory complications are a concern and the patient should be recovered in a monitored setting until they return to their baseline.