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

Prevalence, Clinical Presentation, and Associated Risks of OSA

OSA is very common, affecting approximately 5% of Western populations.[10] This is likely an underestimation because various prevalence studies have shown higher incidence in certain groups, such as middle-aged men.[11] Symptoms common to the clinical presentation include:

  • Loud interrupted snoring;

  • Nocturnal gasping episodes;

  • Nonrefreshing sleep; and

  • Excessive daytime sleepiness.

These are often accompanied by:

  • Nocturia;

  • Gastroesophageal reflux disorder; and

  • Morning headache.

The diagnosis is made by nocturnal polysomnography, which evaluates the various parameters of sleep, along with[12]:

  • Airflow;

  • Thoracoabdominal movements;

  • Oxygen saturation;

  • Body movements; and

  • Cardiac rhythm.

Pathogenesis of sleep apnea.

The Figure shows how OSA is part of a continuum that ranges from normal breathing during sleep, to simple snoring, to OSA, and ultimately to respiratory failure. Most patients with suspected OSA seek evaluation because their sleep is reported as not refreshing, and their bed partner complains about his/her own sleep disruptions by the loud snoring and restless sleep. Research has shown an ongoing link between OSA, cardiovascular disease, and diabetes. Cardiovascular diseases associated with OSA include[13]:

  • Hypertension;

  • Congestive heart failure;

  • Cardiac ischemia;

  • Stroke; and

  • Atrial fibrillation and other cardiac arrhythmias.

Untreated OSA carries a risk for higher incidence and mortality from these associated diseases. The common link between cardiovascular diseases, diabetes, and OSA is likely the oxidative stress that occurs as a result of the repeated episodes of hypoxemia, which increases:

  • Sympathetic activation;

  • Endothelial dysfunction;

  • Inflammation; and

  • Production of vasoactive substances, such as cytokines.

Early recognition and appropriate therapy, most commonly with the nocturnal use of continuous positive airway pressure (CPAP), can lead to a decreased incidence of these complications.[12]

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