Sleep disordered breathing is a common problem affecting all age groups, particularly in association with certain other medical conditions and syndromes. The pathological consequences of the disorder may be severe, with significant implications for the perioperative management of sufferers. Research into the effects of surgery and anaesthesia on sleep is very much in its infancy. Understanding of the implications of sleep disturbance and sleep disordered breathing for perioperative morbidity and mortality is limited. While several observations have led to considerable speculation in the literature, evidence of a causal relationship is still largely lacking. Anaesthetists are ideally placed to screen large numbers of people for sleep disordered breathing, a source of considerable community morbidity. Recognizing the symptoms, signs and associations of the condition during the preoperative visit is important in planning management, as is recognition of the likelihood of OSA in patients who present difficulty with tracheal intubation or airway maintenance. Particular care is required in the perioperative management of patients with diagnosed or suspected sleep apnoea.