Patients with obstructive sleep apnea (OSA) are at increased risk to sustain adverse events during the perioperative period including difficulty with airway control, hypoxemia, airway obstruction requiring reintubation, arrhythmias, myocardial ischemia, and death. Numerous factors appear to be responsible for these consequences, including the effects of anesthetic agents, narcotics, postoperative supine positioning and, in some cases, the surgical intervention itself. The situation is complicated by the fact that most patients with OSA are undiagnosed and there is often insufficient time for adequate evaluation prior to surgery. Perioperative care providers need to maintain a high index of suspicion for OSA and should consider guidelines to help with the recognition and management of these patients. This review will discuss the available literature regarding the preoperative, intraoperative and postoperative evaluation and management of patients with known or suspected OSA undergoing surgery.