Anesthesia and surgical interventions significantly alter structures and neural control of the respiratory system, resulting in adverse postoperative respiratory complications, particularly in obese patients with obstructive sleep apnea. Current understanding of the pathophysiology of obstructive sleep apnea supports perioperative lung volume maintenance strategies, optimal postoperative positioning such as sniffing head position and sitting posture, and oxygen administration in addition to application of continuous positive airway pressure. These strategies are speculative and need collaborative investigations between anesthesiologists and sleep physicians.