Due to its low rate of diagnosis, in the general population over half of those experiencing obstructive sleep apnea (OSA) are unaware that they have the condition. However, any acute medical event may exacerbate OSA and could have serious health consequences. In this context the management of the perioperative period, from anesthesia through the surgery itself and into the postoperative period, is more problematic for patients with sleep disordered breathing than for others. There is prolific literature in this area although large randomized trials are few due to the high sample size needed and possible ethical difficulties of withholding OSA treatment in the perioperative period. In 2014 the American Society of Anesthesiologists published an updated set of recommendations to guide OSA management during the perioperative period. In this present review we provide an overview of the different issues that practitioners face with regard to OSA, from the initial consultation with the anesthesiologist to the extended post-operative period. There is considerable evidence that OSA patients are at high risk of perioperative complications, though the inherent risks from OSA per se and its comorbidities remain difficult to discern. Nevertheless, appropriate screening and management allow clinicians to minimize OSA associated risk.