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

The Challenge of Creating New Assessment Standards

Proceeding with new standards is difficult at any institution. The key is to develop the message from the latest practice standards by using a collaborative team approach. Together, evaluation of the impact on all departments can be defined. For a successful approach, leaders involved should include:

  • Registered nurses;

  • Respiratory therapists;

  • Chief nursing officers;

  • Medical directors;

  • Anesthesiologists; and

  • Sleep physicians.

Use of a model, such as the Iowa model, helps delineate the steps to include when evaluating the application of evidenced-based OSA criteria for practice.[14] This model allowed for the recognition that, in order to manage the risk for sleep apnea appropriately and achieve more positive outcomes of care, screening needs to occur for all patients. Patients who are not assessed for sleep patterns miss the opportunity for appropriate interventions. Therefore, the total management of their care can be missed or delayed.

The first screening tool used for inpatients is the clinical assessment and possible nocturnal sleep oximetry study. This test measures scoring of respiratory disturbance events in a given time period related to oxygen saturation.[15] When patients are tested on oxygen devices, these results are sometimes inconclusive, and further polysomnography is recommended. Posthospitalized patients are advised to discuss with their primary physician the identified risk during their hospital stay and determine the need for a formal sleep study. Predicting criteria by Rowley and colleagues[2] set measurable, valid, and reliable factors that determine risk for sleep apnea, including:

  1. Daytime sleepiness;

  2. Men 40 years of age or older;

  3. Neck size;

  4. Overweight -- body mass index ≥ 30 kg/m2;

  5. Insomnia or poor quality of sleep;

  6. Snoring; and

  7. Pause in breathing during sleep.

A California experience. An evaluation of 7 local California hospitals occurred prior to beginning the process at the one particular community hospital. The purpose was to evaluate the application of sleep pattern questions on admission. The results indicated that none of the hospitals used predictors consistently, but roughly 49% reported using some established evidence-based predictors as part of their admission assessment. Gathering information from local hospitals benefited the momentum and encouraged the team to carry the project forward to change practices at the hospital.

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