Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder with an increasing prevalence. Affected individuals suffer from a repetitive partial or complete occlusion of the pharyngeal airway despite continued respiratory efforts leading to sleep fragmentation, abnormal gas exchange and significant cardiovascular and metabolic morbidity. Surgical patients with OSA, which in the majority of cases has not been diagnosed prior to surgery, have an increased risk of developing a variety of pulmonary, cardiovascular and other complications throughout the perioperative period. Certain actions may contribute to increase the safety of patients with OSA during this time. Among them are preoperatively, a timely recognition and assessment of OSA and potentially co-existing diseases, intraoperatively, the selection of an appropriate anaesthesia and monitoring technique, and postoperatively, the continuation of monitoring for an adequate period of time with the option of intensive care treatment. The actual clinical approach should follow the risk profile of the individual patient which is determined by OSA severity, invasiveness of the surgical procedure and requirement for postoperative opioids as well as the incidence of critical events in the early postoperative period. Initiated and mandated by the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery, and conceived on the basis of the available literature and existing guidelines, the following paper provides recommendations for the perioperative management of adult patients with OSA in ENT surgery.