NURS 1250: Sleep Apnea Nursing Care

Oxygenation and Sleep-Rest Disorders: Nursing Care of the Patient with Sleep Apnea

• Course Information: NURS 1250/1610, taught by Victoria Leonetti, MSN, RN, and Emily Raddell, MSN, RN

Student Course Learning Outcomes

• Provide: Provide safe, patient-centered, evidence-based nursing care guided by the Caritas philosophy.
• Demonstrate: Demonstrate intermediate levels of critical thinking and clinical reasoning to provide quality patient care.
• Relate: Relate the impact of quality improvement measures to improved patient care.
• Explain: Explain management of care concepts for adult patients.

Pathophysiology & Etiology: Sleep Apnea (Obstructive)

• OSA: A breathing disorder marked by a narrowing of the upper airway, obstructing airflow during sleep. This can be complete or partial.
• Obstruction Cause: Soft palate, tongue, and uvula.
• Apnea: Significant reduction or cessation of breathing during sleep.
• Frequency: Unofficially, greater than 10-20 seconds of pauses followed by loud snoring or awakening; episodes can occur hundreds of times per night.
• Diagnostic Threshold: 5 or more apneic episodes per hour is considered diagnostic.
• Disruption of Sleep: Repeated disruption of deep sleep.
• Physiological Impact: Increased blood CO2 levels, decreased blood pH (acidotic).
• Prevalence: Estimated >12 million people affected (18-25 million estimated).

Pathophysiology and Etiology: Obstructive Sleep Apnea

• Upper Airway Relaxation: Oral and upper airway soft tissues relax during sleep.
• Airflow Blockage: Relaxed tissues block the passage of air to the lungs.
• Apneic Episodes: Result in hypoxemia (low blood oxygen), particularly for the brain, triggering arousal from sleep to resume breathing.
• Sleep Return: Patient falls back into deeper sleep cycles.

Obstructed vs. Normal Airway

• Obstructed: The airway collapses during sleep, no air movement, typically a gasp/snort at the end of the apnea phase.
• Normal: The airway remains open and unobstructed during sleep.

Risk Factors

• Obesity: Men affected more than women (14% for men compared to 5% for women). Neck circumference (>17 inches in males, >16 inches in females indicate increased risk.
• Anatomy: Enlarged tongue, uvula, tonsils, adenoids, small upper airway, recessed chin.
• Genetics: Possible genetic predisposition.
• Other Factors: Diabetes, hypertension, cigarette smoking.

Clinical Manifestations

• Snoring: Loud snoring.
• Gasping/Choking: Occurrence during sleep.
• Frequent Nighttime Awakenings.
• Apnea Episodes: Five or more episodes per hour, each lasting 10-20 seconds
• Irritability: Common symptom
• Morning Headaches: Common symptom
• Daytime Drowsiness. Common symptoms.

Diagnostic Tests: STOP-BANG Score

• Snoring: Loud snoring.
• Tired: Excessive tiredness or sleepiness during the day.
• Observed: Has anyone observed you stop breathing or gasp/choke during sleep?
• Pressure: Have high blood pressure?
• Body Mass Index (BMI): More than 35 kg/m2?
• Age: Over 50 years old?
• Neck Size: Large neck size (measured around Adam's apple).
• Gender: Male.

Diagnostic Tests: Additional Procedures

• Polysomnography (Sleep Study): Measures to assess issues during sleep: air flow, blood oxygen levels, heart rate, breathing patterns, eye/leg movements, and brain waves (EEG) linked with NREM and REM stages.

Nonpharmacologic Therapy

• Weight Reduction: Significant weight loss linked to apnea improvements
• Avoid Alcohol: Avoid consumption before sleep.
• Smoking Cessation: Beneficial for respiratory health
• Side-Lying Position: Avoid supine sleep position.
• Continuous Positive Airway Pressure (CPAP): Prevents airway collapse during sleep.
• Bi-Level Positive Airway Pressure (BiPAP): Offers different pressures during exhalation and inhalation for improved ventilation.

Surgery

• Surgical options: Used if non-pharmacologic therapy is ineffective. Includes:
• Tonsillectomy/Adenoidectomy: Removing tonsils and adenoids.
• Partial soft palate/uvula removal: Portions removing soft palate/uvula.
• Uvulopalatopharyngoplasty (UPPP): Surgery to remove the uvula, soft palate, and pharyngeal tissue to open airways.