Copy reviewed by Ann Dietrich, MD, FAAP, FACEP.
Obstructive Sleep Apnea Etiology and Epidemiology
Obstructive Sleep Apnea (OSA) is characterized by episodes of apnea, or cessation of breathing during sleep, lasting from 10 seconds to over a minute, potentially occurring more than 100 times per night. These interruptions often result in daytime sleepiness and reduced energy levels.
Symptoms of OSA include
- Loud snoring
- Cognitive deficits
- Restlessness at night
- Insomnia
- Frequent nocturnal awakenings
- Morning headaches
- Choking or gasping upon waking
- Lack of concentration
- Vivid dreams
- Mood changes
- Daytime sleepiness
OSA occurs when the muscles supporting the soft palate, uvula, tonsils, throat walls, and tongue relax, narrowing or closing the airway, leading to decreased oxygen levels in the blood (Mayo Clinic, 2020).
ICD-10 Code:
- G47.33 - Obstructive sleep apnea (adult) (pediatric)
Risk Factors
- Men are more prone than women
- Higher body mass
- Neck circumference over 17 inches in men, 16 inches in women
- Enlarged tongue, adenoids, or tonsils
- Smoking
- Family history of OSA
- Nasal congestion
- Craniofacial deformities
- Hypothyroidism
- Cardiovascular disease
- Hypertension
- Age over 50
OSA Diagnosis
A definitive diagnosis requires a sleep study (polysomnography), either overnight in a sleep lab or at home with special equipment. This study includes EEG, EOG, and EKG, which measure brain waves, eye and chin movements, and heart rhythm/rate, respectively. Chest bands measure respiration, and monitors record oxygen saturation and leg movement (American Sleep Apnea Association, 2021).
The apnea-hypopnea index (AHI) classifies OSA severity:
- Mild: AHI of 5-15
- Moderate: AHI of 15-30
- Severe: AHI of 30 or more
Management
OSA complications include:
- Heart failure
- Cor pulmonale
- Erectile dysfunction
- Accidents due to daytime sleepiness
- Acute blood pressure elevations
- Personality changes or depression
- Ventricular arrhythmias
- Pulmonary hypertension
- Nonalcoholic fatty liver disease
- Metabolic syndrome
- Decreased quality of life from chronic sleep deprivation
- Death due to arrhythmias, cardiac ischemia, or hypertension complications
Treatment Options:
- Positive Airway Pressure (PAP) therapies: CPAP, BiPAP, auto-titrating devices
- Oral appliances for mild to moderate OSA intolerant of PAP (Laratta et al., 2017)
- Oropharyngeal muscle exercises
- Tonsillectomy and adenoidectomy
- Nasal expiratory positive airway pressure valves
- Maxillomandibular advancement
Obstructive Sleep Apnea Nursing Care Plan
Nursing Considerations
Assessment
Assess signs and symptoms:
- Respiratory status
- Oxygen saturation
- Vital signs
- Sleep quality
- Daytime fatigue
- Snoring
Screen individuals with daytime fatigue or other risk factors for OSA.
Nursing Diagnosis/Risk For
- Ineffective breathing pattern related to sleep apnea evidenced by:
- Periods of apnea during sleep
- Decreased oxygen saturation
- Shallow breathing
- Impaired gas exchange related to altered oxygen supply secondary to sleep apnea evidenced by:
- Decreased oxygen saturation
- Periods of apnea during sleep
- Sleep deprivation related to OSA evidenced by:
- Interrupted sleep
- Irritability
- Complaints of not feeling rested
Interventions
- Monitor skin and mucous membrane color for cyanosis
- Assess vital signs, especially respiratory rate and oxygen saturation during sleep
- Auscultate lungs for abnormal breath sounds
- Provide PAP and supplemental oxygen as ordered
- Refer to a sleep specialist
- Assist with repositioning to elevate the head of the bed and discourage supine position
- Administer medication as ordered
- Use pulse oximeter and apnea monitor during sleep
Expected Outcomes
- Maintains effective breathing pattern and adequate oxygenation
- Reports restful sleep
- Demonstrates effective coping
- Uses and maintains sleep equipment as recommended
Individual/Caregiver Education
- Condition, treatment, and expected outcomes
- Avoid sedative and alcohol use
- Importance of treatment compliance
- Sleep hygiene, weight loss, and side sleeping
- Recommended follow-up with healthcare providers
- Immediate medical care for acute elevations in blood pressure, chest pain, or shortness of breath
FAQs
Additional Information
Content Release Date
3/31/2022
Content Expiration
12/31/2025
Course Contributor
Kim Matthews, RN, with over 20 years of experience, including extensive work in Skilled Nursing and Post-Acute Care, developed this content.
References
- American Sleep Apnea Association. (2021). What is sleep apnea? Link
- Kompelli, A.R., Ni, J.S., Nguyen S.A., Lentsch, E.J., Neskey, D.M., & Meyer, T.A. (2019). The outcomes of hypoglossal nerve stimulation in the management of OSA: A systematic review and meta-analysis. World J Otorhinolaryngol Head Neck Surg. Link
- Laratta, C.R., Aya, N.T., Povitz, M., & Pendharkar, S.R. (2017). Diagnosis and treatment of obstructive sleep apnea in adults. Canadian Medical Association Journal. Link
- Mayo Clinic. (2020). Sleep apnea. Link
- Pacheco, D., & DeBanto, J. (2020). Obstructive sleep apnea. Link
- Slowik, JM., Sankari, A., Collen, JF. (2024). Obstructive Sleep Apnea. StatPearls Publishing. Link