Nursing Assessment for Predicting Obstructive Sleep Apnea: Community Hospital Approach

Angela P. Halpin, MN, CNS, RN; Jennifer M. Bunting, AAS; Paul A. Selecky, MD; Suzette G. Bosveld, RN, BSN, MSN, CCNS, NP-C; Derrick Hong, MD

Disclosures

Topics in Advanced Practice Nursing eJournal. 2008;8(1) 

In This Article

Introduction

Over the past decade, more and more comprehensive questions or criteria to assess the wellness of patients have been developed for physicians and nurses. These instruments assist professionals in using research-based nursing models, clinical standards, and typologies to serve patient populations.[1] Sleep patterns are presented as part of the functional listings. Questions related to sleep are slowly becoming part of acute care admission and surgical reviews, particularly with regard to obstructive sleep apnea (OSA). Literature continues to promote reliable and measurable screens to sort issues that affect patient healing in an acute health episode.[2] The underestimation of sleep apnea may be due to[3]:

  • Poor assessment of sleep patterns in hospital settings;

  • Lack of assessment of sleep patterns in hospital settings; and

  • Lack of sleep medicine training among healthcare professionals.

Assessment changes have been driven by the Centers for Medicare & Medicaid and the National Institutes of Health, among other organizational bodies. Some of these assessments involve criteria related to:

  • Fall precautions;

  • Stroke scales; and

  • Pain management.

Studies of predictors and correlations have succeeded in gaining ground in care initiatives. Most recently, the Joint Commission on Accreditation of Healthcare Organizations set forth a proposed hospital safety standard for 2008 to screen for OSA while the American Academy of Sleep Medicine[4] and American Society of Anesthesiologists guidelines are adopted.[5] These requirements maintain good nursing practice, including assessment for sleep apnea risk.

Research continues to link OSA with an increased risk for cardiovascular adverse events, such as[6]:

  • Hypertension;

  • Myocardial infarction;

  • Cardiac arrhythmias; and

  • Stroke.

In a prospective study, increased cardiovascular mortality was linked with untreated OSA or central sleep apnea.[7] Healthcare providers must identify patients at risk for cardiovascular morbidities, including conditions, such as OSA, that accentuate or aggravate underlying cardiovascular disease and contribute to or even lead to hospital admission. Studies have revealed, for example, that as many as 70% of patients admitted following a stroke have sleep apnea.[8]

Literature has shed light on sleep patterns as a factor affecting risk to patients of all ages, including children.[9] The main physiologic systems affected by sleep patterns include:

  • Heart;

  • Pulmonary; and

  • Neurologic.

Each of these systems is affected by oxygen desaturations, thereby prompting sleep pattern interruptions.[4]

Consistency is sporadic at best in community hospitals for assessment of sleep patterns, but there are sleep evaluations completed by:

  • Anesthesiologists;

  • Nurses on specific units; and

  • Respiratory therapists.

The current article proposes a collaborative process to design tools for patient assessment of sleep patterns in both inpatient and outpatient areas of a community hospital. The goal is to implement sleep assessment by both physicians and nurses.

The addition of sleep pattern questions or screens on both admission and surgical nursing assessments is a method to provide consistency for identifying patients with sleep challenges at the time that care is initiated. Once the process and the questions are identified, screens and physician communication can occur to assess the level of risk. Succinct evidence-based questions can ensure differentiation of cued data collection.

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