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Sleep Apnea Cheat Sheet by

Iggy Nursing
med-surg     ignatavicius

Pathop­hys­iology

Breathing Disruption during sleep the lasts at least 10 seconds and occurs a minimum of five times in an hour.
Most common airway obstru­ction by soft palate or tongue.

Risk Factors

Obesity (Modif­iable)
A large Uvula (Non-m­odi­fiable)
Short neck (Non-m­odi­fiable)
Smoking (Modif­iable)
enlarged tonsils or adenoids (Both)
oropha­ryngeal edema (Non-M­odi­fiable)
Male gender (non-m­odi­fiable)
High Blood Pressure (Both)
Long term effects of chronic OSA includes increase risk for HTN, Stroke, Cognitive deficits, weight gain, Diabetes, and Pulmonary and Cardio­vas­cular disease

Signs and Symptoms

Snoring heavily
Transient Apnea
Excessive daytime sleepiness
Morning headache
Insomnia
Restless Sleep (waking up tired)
Nightmares
Memory loss
Perfor­mance defici­encies
GERD
Depression
Moody (perso­nality changes)
Nocturia
Impotence
Usually verified by family members who observe the problem when the adult sleeps.
 

Interv­entions

Positional Therapy
Mild sleep apnea can be treated by changing the patient's sleeping position. Sleeping on one's side, or with the head of the bed elevated can help to reduce or eliminate episodes of apnea.
Oral Appliance
Use of an oral appliance, such as a mouth guard, may help to prevent obstru­ction of the patient's airway by shifting the jaw and tongue forward.
Continuous Positive Airway Pressure (CPAP)
CPAP therapy is used in patients w/ severe OSA who experience 15 or more episodes of apnea in one hour. CPAP provides positive pressure upon both inspir­ation and expira­tion, to maintain an open airway. An Altern­ative interv­ention called believe positive airway pressure (BiPAP) can also be used to treat OSA. This type of therapy may be better tolerated by patients due to higher inspir­atory pressure, and lower mean presets during expira­tion.
Surgery
Surgey may be indicated to treat OSA if the other non-su­rgical interv­entions are ineffe­ctive. A uvulop­ala­top­har­yng­oplasty (UPPP) can be preformed to remove tissues in the throat, such as tonsils, uvula, and soft palate, that are causing airway obstru­ction.
Patients should be educated about what to expect after surgery, including sore throat, halitosis (bad breath), and snoring.
 

Assessment : Nursing

The most accurate test for Sleep Apnea is an overnight sleep study. The patient is directly observed while wearing a variety of monitoring equipment to evaluate depth of sleep, type of sleep. respir­atory effort, oxygen satura­tion, and muscle moveme­nt.M­on­itoring devices include an electr­oen­cep­hal­ogram (EEG), and electr­oca­rdi­ograph (ECG), a pulse oximeter, and electr­omy­ograph (EMG).
Patient are often unaware that they suffer from sleep apnea. A beginning assessment includes having the patient complete the STOP-Bang Sleep Apnea Questi­onnaire

Pharma­logical TX

One drug that has been approved to help manage the daytime sleepiness associated with OSA (modafinil [Attence, Provigil]) and may help patients who suffer from narco­lepsy (uncon­trolled daytime sleep) by promoting daytime wakefu­lness. This drug does not treat the cause of OSA. Sleep-­Ind­ucing sedatives also are not considered first-line therapy.

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