M2 - Obstructive Sleep Apnea

Obstructive sleep apnea (OSA)

a common, chronic disorder characterized by recurrent episodes of partial or complete upper airway obstruction during sleep, leading to pauses in breathing or periods of shallow breathing; breathing stops during sleep >10 seconds and >5x/hour

Nocturnal symptoms

• loud, habitual snoring with pausing

• gasping or choking during sleep

• restless sleep

• frequent awakenings

• bedwetting or excessive urination

Daytime symptoms

• excessive daytime sleepiness (EDS) or fatigue

• morning headaches

• difficulty concentrating

• memory problems

• irritability

• non-restorative sleep

• reduced sex drive

Priority nursing diagnoses

• disturbed sleep pattern r/t recurrent episodes of apnea/hypopnea, frequent arousals, and non-restorative sleep

• fatigue r/t chronic sleep deprivation and fragmented sleep

• risk for ineffective breathing pattern r/t upper airway obstruction during sleep

• deficient knowledge r/t disease process, health implications, proper use and maintenance of treatment devices, and lifestyle modifications

• risk for non-adherence r/t discomfort, perceived inconvenience, claustrophobia, or lack of understanding

• risk for CV complications r/t chronic intermittent hypoxia and sympathetic nervous system activation

Etiology and risk

• most common cause is upper airway obstruction by the soft palate or tongue

• obesity

• large uvula

• short neck

• smoking

• enlarged tonsils/adenoids

• oropharyngeal edema

• genetic/congenital structure variations

Diagnostics

• STOP-bang sleep apnea questionnaire (>3 = high risk)

• pulmonary function tests (PFTs)

• sleep study (polysomnogrpahy)

• EEG

• ECG

• O2 saturation

• EMG

Medications

• antidepressants

• Modafinil - may help with narcolepsy but doesn’t treat cause

Procedures

• ENT referral

• adenoidectomy

• uvulectomy

• uvulopalatopharyngoplaty

• children tonsillectomies (less difficult/dangerous than adult)

Nursing care

• change of sleep position

• weight loss

• avoid alcohol

• positive pressure ventilation

• CPAP/BiPAP machine

• avoid sedatives

CPAP

• continuous positive airway pressure

• constant airflow

BiPAP

• bilevel airway pressure

• more pressure when breathing in

• less pressure when breathing out

APAP

• auto titrating positive airway pressure

• adjusts constantly

• algorithmic control