Obstructive Sleep Apnea

Definition/Etiology:

• Definition
  • Apnea is defined as cessation of airflow for more than 10 seconds. Sleep apnea is
    defined as repeated episodes of upper airway obstruction associated with obstructive apnea and hypopnea during sleep together with daytime sleepiness or altered cardiopulmonary function.
• Etiology
  • Obesity
  • Nasal Obstruction
  • Adenoids/Tonsils
• Analogy
  • Imagine trying to drink a milkshake through a paper soda straw. As you suck in, the weak paper straw collapses, and you don’t get any of the milkshake. This collapsing is similar to what happens to people with OSA, but instead of missing
    out on a milkshake, they don’t get enough air into their lungs.

Pathophysiology:

• Definitive event in obstructive sleep apnea is the posterior movement of the tongue and palate into apposition with the posterior pharyngeal wall, which results in occlusion of the nasopharynx and oropharynx.
• Following the obstruction and resultant apnea, progressive asphyxia develops until there is a brief arousal from sleep, restoration of upper airway patency, and resumption of airflow. Patient quickly returns to sleep, only to experience the sequence of events over and over again.

Noticing: Assessment & Recognizing Cues:

• Subjective Cues
  • Daytime Sleepiness
  • Fatigue
  • Loud Snoring
  • Morning headaches
• Objective Cues
  • STOPBANG Questionnaire
    • snoring, tiredness, observed apnea, high BP, BMI, age, neck circumference, and male gender
  • Septal deviation
  • Oropharynx narrowing (tonsillitis?)
  • Thick Neck circumference

Interpreting: Analyzing & Planning:

• Labs
  • ABGs
    • C02 ↑ 45 if severe
  • HgbA1c
    • High correlation with DM
  • CRP
    • Causes inflammatory changes
• Diagnostics
  • Sleep Study
    • Inpatient or at home
  • Pulse Oximetry
    • Low when apneic
  • Heart Monitor
    • Afib is common

Responding: PatientInterventions & Taking Action:

• ABCs
  • CPAP/BiPAP
    • CPAP machines are primarily used to treat Obstructive Sleep Apnea (OSA)
    • BiPAP = Apnea + COPD
• Pharmacological
  • Avoiding alcohol, narcotics and sedatives
  • Cannot slow down respiratory drive
• Interventions Non-Pharmacological
  • Positioning
    • HOB 30-45%
    • Neck neutral
• Adjunct Medical Therapy
  • RT & Sleep Study Staff

Reflecting: Evaluating Patient Outcomes:

• Oxygenation & Gas Exchange
  • Vitals & Labs
• Symptoms
  • Patine reports change in daytime sleepiness
• Patient Education
  • Proper use of equipment
    • CPAP cleaning care
    • Assess for noise ( lack of seal )
• Compliance
  • Severe cardiac consequences related to hypoxia. Remember Afib leads to Stroke!

Linchpins (Key Points):

• Notice
  • C/O of daytime sleepiness and questionnaire depending where you work
• Interpret
  • Sleep study – HCP
  • Heart Monitor – Asleep and slipping into Afib
• Respond
  • CPAP/BiPap + Hob 30% and neck neutral
• Reflect
  • Patient Alert? Safe with equipment? Understand consequences of not wearing it?