Week 6: Obstructive Sleep Apnea (OSA) Upper Respiratory Disorder

Question 1

Epidemiology

Answer 1

• occurs during sleep
• upper airway is obstructed causing a narrowing of one of more sites of the upper airway, resulting in intermittent breathing patterns

Question 2

Pathophysiology

Answer 2

• occurs during sleep as the upper airways narrow or collapse, increasing resistance to airflow; causing intermittent breathing patterns
• airflow blocked to lungs
• periods of apnea

Question 3

What Happens during OSA

Answer 3

-with the onset of sleep, the body muscle tone relaxes, which includes the muscles of the upper airway
>With OSA, the normal work of breathing is unable to overcome the increased resistance in the upper airway, causing airway collapse.
>narrowing of the upper airways increases inspiratory pressure and intrathoracic pressure, resulting in decreased ventilation and gas exchange
-periods of apnea; no gas exchange occurs in alveoli

Question 4

What occurs as a result of decreased tidal volume and apnea?

Answer 4

• hypoxemia (decreased concentration of O2 in the blood)
• Hypercapnia (increased concentration of CO2 in the blood)
• acidosis
• increased sympathetic vasoconstrictive activity

Question 5

Clinical Manifestations

Answer 5

• loud snoring
• snorting
• witnessed apnea
• gasping during sleep
• recurrent waking during sleep
• choking

Question 6

What Diagnoses the presence of OSA?

Answer 6

15 or more obstructive sleep events per hour

Question 7

What do patients complain about because of these frequent sleep disturbances?

Answer 7

• excessive daytime sleepiness
• falling asleep during quiet times
• short and repetitive attention lapses
• taking intentional naps

Question 8

Diagnostic Procedures

Answer 8

• begins with sleep history; sleep patterns, history of snoring and daytime sleepiness
• polysomnography (a sleep study)

Question 9

Diagnostic Procedures: Polysomnography

Answer 9

a sleep study

• biophysical measurements are obtained; electrocardiogram, pulse oximetry, respiratory airflow, eye and skeletal muscle movement, and an electroencephalogram
• apnea-hypopnea index value, number of apneic events per hour, is key value

Question 10

Treatment Procedures

Answer 10

• CPAP
• weight management
• using pillows for a non-supine position
• oral appliances
• surgical management for primary or secondary interventions

Question 11

Treatment: CPAP

Answer 11

• treatment of choice
• weight management and loss is the first line intervention in conjunction with CPAP
• continuous positive airway pressure prevents collapse of the upper airway through the use of nasal, oral, or oronasal mask during sleep
• CPAP machine delivers a continuous stream of positive pressure, keeping the airway open and providing an unobstructive airway

Question 12

Treatments: Surgical Management

Answer 12

-Primary: for patients with severe obstructing anatomy that surgery can correct
-Secondary: patients who are intolerant of CPAP or oral appliances
>tonsillectomy and/ or adenoidectomy, uvulopalatopharyngoplasty, septoplasty, nasal polypectomy, tongue reduction, and epiglottoplasty
>these procedures remove excess tissue in the airway that interferes with maintaining adequate airflow
>bariatric surgery to consider weight reduction is also a consideration

Question 13

Complications

Answer 13

• mediator of cardiovascular disease because of recurrent hypoxemia
• severe nocturnal hypoxemia can result in cardiac ischemia, myocardial infarction, erectile dysfunction, stroke, atrial fibrillation, heart failure, and sudden cardiac death

Question 14

Risk Factors

Answer 14

• history of A-fib, nocturnal dysrhythmias, type 2 diabetes, heart failure, pulmonary hypertension
• others: gender(mostly men), obesity, craniofacial or upper airway soft tissue abnormalities, and menopause

Question 15

Treatment: Oral Appliances

Answer 15

• custom-made to the patient; may be used to maintain airway patency
• assist with mandibular repositioning to hold the mandible in a forward position to keep the airway open
• positioning of the tongue is accomplished with tongue-retaining devices

Question 16

Nursing Care

Answer 16

• assess vital signs (hypertension and dysrhythmias are common)
• assess height and weight (obesity risk factor)
• assess sleep, rest, and activity history (disruptive sleep patterns, daytime fatigue, increased sleepiness, and presence of snoring indicate OSA)
• assess for edema, bleeding, and respiratory distress postoperatively if surgical option is pursued
• administer medications as ordered (for uncontrolled hypertension or cardiac dysrhythmias
• diagnostic studies

Question 17

Client Education

Answer 17

• avoid alcohol and sedatives before bedtime
• instruction on CPAP
• discuss disease process
• medication use
• instruct patient on weight reduction and management if obesity is a risk factor

Question 18

Assessment Tool: STOP BANG

Answer 18

>STOP= symptoms
>BANG= risk factors

Question 19

Assessment Tool: STOP BANG; STOP indications

Answer 19

Symptoms
S= do you snore or has someone told you that you snore?
T= tired all the time
O= observed to stop breathing
P= pressure elevate (HTN)

Question 20

Assessment Tool: STOP BANF: BANG indications

Answer 20

Risk Factors
B= BMI increased
A= age >50
N= neck > 17 male or >16 female
G= gender/ male