Obstructive Sleep Apnea Flashcards
What is obstructive sleep apnea?
Cessation of breathing (apnea) during sleep usually caused by repetitive upper airway obstruction
Larger neck circumference, increased peripharyngeal fat, and upper airway is compressed all fall under which risk factor?
Obesity
Being male, post-menopausal status, advanced age, tonsillar hypertrophy, posterior positioning of the jaw and variation in craniofacial structures are all what?
Other risk factors
How many apneic events are normal?
Up to 5 in an hour, w/ no D-sat
What constitutes severe obstructive sleep apnea?
Over 30 events in an hour
What nervous system is triggered that causes respiration’s, heart rate and blood pressure to increase during obstructive sleep apnea?
Sympathetic
What do OSA pt’s have a higher incidence of?
HTN, MI, stroke and pulmonary HTN
What are the 3 S’s to the clinical manifestations of OSA?
Snoring, sleepiness and significant other reports of sleep apnea events
Clinical manifestations of OSA?
Insomnia, nighttime/early morning awakenings w/ an inability to return to sleep and morning HA, chronic fatigue, daytime sleepiness, frequent MVA
Describe the apneic events of a pt w/ OSA?
Frequent/loud snoring w/ breathing cessation for 10sec for greater than 5epsisodes per hour to several hundred per night followed by awakening abruptly w/ a loud snort as blood O2 levels drop
What is the definitive study done to diagnose OSA?
Polysomnography (sleep study)- overnight test that keeps track of # of apneic events in an hour
What does a polysomnography measure?
EEG, electrooculogram, ECG, respirations, cardiac dysrhythmia, leg movements and pulse ox
What are some important medical/nursing management that needs to be done in a pt w/ OSA?
Weight loss, avoidance of alcohol, position therapy (not on back), oral appliances, CPAP/BiPAP (if severe), can add supplemental O2 via NC
What is CPAP?
Continuous positive airway pressure: pushes air in continuously
What is BiPAP?
Bilevel positive airway pressure: Has IPAP (Inspiratory positive airway pressure) and EPAP (Expiratory positive airway pressure)
What should always be used w/ a CPAP?
Distilled water and a humidifier (to reduce airway dryness)
What is the surgery termed Uvulopalatopharyngoplasty?
Removal of pharyngeal soft tissue and removal of a portion of soft palate and uvula
What is the surgery termed maxilomandibular surgery?
Advance the mandible and maxilla forward
What is a curative surgical management for OSA?
Tracheostomy
Tonsillectomy, adenoidectomy and nasal septoplasty are what?
Types of surgical
What medication is a stimulant that decreases daytime sleepiness?
Modafinal (Provigil)
What medication is taken @ bedtime; increases respiratory drive and improves upper airway muscle tone?
Protriptyline (Tripityl)
Disturbed sleep pattern, anxiety, ineffective breathing pattern, impaired gas exchange, deficient knowledge, activity intolerance, risk for injury and fatigue are all what?
Nursing diagnosis
What are some important nursing actions?
Teaching about obesity and sleep apnea, avoidance of alcohol/sedatives, how to use CPAP and measures to reduce airway dryness
What type of sleep apnea occurs when there is a blocked airway by the soft palate, tongue and/or uvula?
Obstructive
What type of sleep apnea occurs when the muscles of the chest and diaphragm fail temporarily?
Central
How does a BiPAP differ from a CPAP?
A BiPAP produces less pressure during exhalation and more during inhalation causing less resistance to exhalation
What are the 3 modes of ventilation for a BiPAP?
1: spontaneous breathing (S). 2: Timed mode (T) (pressure supported breaths are delivered @ a predetermined rate) 3: Spontaneous/Timed (S/T) switches to timed mode if spontaneous breathing fails below a preset rate
