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

Review of the Literature

"Sleep disturbances occur in about 12% to 25% of the general population and are often associated with situational stress, illness, aging and drug treatment.[17]" According to the American Academy of Sleep Medicine, the general evaluation of patients by the examiner should include reports in regard to each of the following[18]:

  • Snoring;

  • Apnea;

  • Nocturnal choking or gasping;

  • Restlessness; and

  • Excessive daytime sleepiness.

Objective testing is required to determine the diagnosis.

Sleep patterns can affect various pathophysiologic states. When a patient reports frequent awakenings secondary to impaired oxygen delivery, conditions exacerbated may be[19]:

  • Angina;

  • Peripheral arteriosclerosis; or

  • Pulmonary disorders.

The obesity epidemic in the United States has also increased the risk for comorbidity of medical issues, such as sleep apnea.[3] Unfortunately, the issue has been overshadowed by other comorbidities of obesity, such as diabetes and hypertension. The low recognition of sleep apnea may be due to poor or no assessment of sleep patterns in hospital settings or simply the lack of sleep medicine training among healthcare professionals. In addition, screening for sleep pattern disturbances, such as sleep apnea, is often infrequent at the community level. Its importance requires an escalation in awareness for all providers of this as a public health issue.

A meta-analysis on the impact of CPAP on blood pressure of patients with hypertension and OSA demonstrated a reduction in blood pressure when patients with OSA used CPAP.[20] The sample size was 572 subjects from 12 randomized controlled studies. These findings reinforced and sufficiently powered the adoption of implementing the nursing sleep assessment questions. Nurses inquiring about sleep patterns, OSA, and/or use of CPAP at home have enhanced care for the patients at this community hospital.

One advantage to screening for sleep problems is that nurses and patients both receive education on the benefits of assessment along with known information about the rationale and appropriate treatment. Oxygen supplementation, for example, is noted to render more successful outcomes when desaturations occur in those with congestive heart failure.[21] In critical care units, it is evident that the environment plays a role in sleep deprivation. Honkus[22] reported that sleep deprivation can induce a catabolic state and negatively affect the immune system. All of these facts assist in the credibility of this change process.

Additionally, anesthesia guidelines in 2006 specified management concerns related to patients with OSA risk on the basis of these adopted predictors[5]:

  • Choice of anesthetic technique;

  • Airway management; and

  • Patient monitoring.

These indicate that adaptation to practice is forthcoming. The orchestration and rollout require guidance by leaders in individual facilities performing surgeries.

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