Sleep Obstructive Sleep Apnea (OSA) Fall 2024 PDF

Sleep Exemplar: Obstructive sleep apnea (OSA) Fall 2024 Rebecca Jones MN, RN, GNC(C), LC What is OSA? Characterized by episodes of a complete (apnea) or partial collapse (hypopnea) of the upper airway with an associated decrease in oxygen saturation or arousal from sleep These dist...

Sleep Exemplar: Obstructive sleep apnea (OSA) Fall 2024 Rebecca Jones MN, RN, GNC(C), LC What is OSA? Characterized by episodes of a complete (apnea) or partial collapse (hypopnea) of the upper airway with an associated decrease in oxygen saturation or arousal from sleep These disturbances results in fragmented, nonrestorative sleep Other symptoms include: loud, disruptive snoring, witnessed apneas during sleep, and excessive daytime sleepiness OSA has significant implications for cardiovascular health, mental illness, quality of life, and driving safety OSA – Burden of Disease Obstructive sleep apnea is a common condition with significant adverse consequences 6.4% of Canadian adults have formal diagnosis…many, many more are unaware they have this issue Males twice as likely as females 60+ population 3x as likely to have OSA US predictions 25-30% of men and 9-17% women meet criteria of OSA Prevalence is high in Hispanic, Black, & Asian populations OSA – Epidemiology OSA is associated with a poor quality of life and is linked with many chronic health conditions including: – Obesity – Diabetes – Metabolic syndrome – Anxiety – Depression Moderate-severe OSA is associated with increased risk of CV disease, resulting in: – Atrial fibrillation – Hypertension – Stroke – Heart failure Risk Factors Let’s discuss this… what are some potential risk factors for OSA? OSA – Clinical Consequences OSA – Pathophysiology (continued) Upper airway obstruction during sleep is often due to negative collapsing pressure during inspiration Progressive expiratory narrowing in the retro palatal area plays an important role The magnitude of upper airway narrowing during sleep is often related to body mass index, indicating that anatomical and neuromuscular factors contribute to airway obstruction OSA – Diagnosis To register as an event, an apnea or hypopnea must last at least 10 seconds or longer A and B, or C satisfy the criteria for a diagnosis of OSA A. The presence of one or more of the following: – The patient reports sleepiness, nonrestorative sleep, fatigue or insomnia symptoms – The patient wakes with breath holding, gasping or choking – The bed partner or other observer reports habitual snoring, breathing interruptions or both during the patient’s sleep – A diagnosis of hypertension, a mood disorder, cognitive dysfunction, coronary artery disease, stroke, congestive heart failure, atrial fibrillation or type 2 diabetes mellitus in the patient B. Polysomnography or home sleep apnea testing shows: – Five or more predominantly obstructive respiratory events per hour of sleep during polysomnography or per hour of monitoring during home sleep apnea testing C. Polysomnography or home sleep apnea testing shows: – Fifteen or more predominantly obstructive respiratory events per hour of sleep during polysomnography or per hour of monitoring during home sleep apnea testing OSA – Diagnosis Definitions of terms quantifying OSA Apnea–hypopnea index (AHI): # of apneas and hypopneas per hour of total sleep time Severity of OSA for adults: Mild OSA: AHI ≥ five events per hour Moderate OSA: AHI ≥ 15 events per hour Severe OSA: AHI ≥ 30 events per hour Adult vs. Pediatric Patient OSA – Treatment Options CPAP – Puts a gentle amount of pressure into the airway – Pushes tongue forward, off the back of the throat allowing airway to open up – First line treatment choice Oral Appliance – Moves jaw forward which moves tongue off back of throat – Good for mild-moderate OSA (AHI 5-30) – Some insurance may want to see you “fail CPAP trial” – OA > CPAP for compliance – Could develop TMJ issues OSA – Treatment Options OSA – Pediatric Considerations OSA – Monitoring Assess for symptom improvement Weight loss strategies Sleep on side Avoid alcohol, sedating medication or opioids Quit smoking Prop up head of bed Treat breathing problems such as stuffy nose Activity NCO à Health & Illness Concepts à Sleep à Case Study or Giddens à Chapter 11, pg. 102 Please complete the case study “Jim” with your group Discussion to follow