Introduction
The article discusses obstructive sleep apnea, a chronic disorder characterized by the obstruction of the upper airways resulting in sleep disruption that could lead to fatigue during the day and the required management. This paper will seek to review the article and evaluate its application to professional nursing practice.
Pathophysiology
The cause of obstructive sleep apnea is multifactorial, but the recurrent collapse of the upper right airway is cited as the primary cause of the condition. The collapse of the upper right airway leads to hypopnea in some cases, while it may cause apnea regardless of the breathing efforts that an individual makes (Carlucci, Smith, & Corbridge, 2013). Some of the obstruction causes include anomalies in the airway, such as a reduction in the activity of the pharynx dilator muscles. Anatomically, the human airway relies on muscles to keep it open as it lacks any bony-structural support to ensure its patency. The issue is further accentuated by the fact that the airway has a collapsible portion extending from the hard palate to the vocal cords area, which mainly assists in the swallowing process (Drager, Togeiro, Polotsky, & Lorenzi-Filho, 2013). The portion is prone to collapsing during sleep and hence results in obstruction and apnea.
Individuals who experience chronic cases of obstructive sleep apnea tend to have anatomically smaller upper airways. Thus, the tubes are much more affected when the collapsible portion between the hard palate and vocal cords collapses during sleep. The inability of the respiratory regulatory centers to control the breathing patterns also contributes to the collapse of the airway.
Persons who experience obstruction of the airway are at a higher risk of developing acidosis and hypercapnia, which then stimulates the respiratory centers leading to heightened activity of the respiratory muscles. Thus, when these increased muscular activities occur, the individual experiences increased breathing efforts which result in sleep disruption to take a breath (Drager et al., 2013). Once the individual takes a breath, they go back to sleep, and the cycle repeats itself, resulting in fragmented sleep. In extreme cases of apnea, the cycle could repeat itself about 100 times per hour. Sleep disruption is accompanied by sympathetic events, which cause vasoconstriction and increased blood pressure, which could potentiate blood vessel damage and hypertension (Pedrosa et al., 2011).
Medical Management
The diagnosis of obstructive sleep apnea can be made using historical evaluation to elucidate clinical features. The is also the need to carry out physical examination and tests to definitively determine the presence of the condition regarding the severity. During history taking, the patients tend to report daytime sleepiness, snoring, and arousal at night, accompanied by gasping. The physical exam includes evaluating the respiratory system to determine the presence of any anomalies, such as tonsillar hypertrophy or macroglossia (Carlucci et al., 2013). Once the patient is identified as having obstructive sleep apnea symptoms, they should be provided with education regarding the possible diagnosis and the confirmatory tests that need to be carried out to ascertain their health condition definitively. The definitive tests carried out on the patients include polysomnography and home-based sleep evaluation, with the latter being recommended for patients with moderate obstructive sleep apnea.
The treatment of obstructive sleep apnea could include different types of interventions ranging from medical to surgical approaches. The condition can be managed through positive airway pressure applied during sleep through CPAP delivered using a face mask attached to the CPAP machine. A full-face mask is indicated for patients who are mouth breathers but could also be replaced by pillow-nasal masks in severe cases of the condition or to increase patient comfort (Carlucci et al., 2013). Oral appliances that increase the pharynx diameter can also be used to prevent airway collapse in patients with obstructive sleep apnea. The oral appliances could be fixed to ensure that mandible remains in a static position or adjustable where a screw is used to ensure the mandible achieves maximum opening. Some of the medications that could be considered for individuals with obstructive sleep apnea include Modanafil and Eszopiclone (Carlucci et al., 2013). The Eszopiclone is effective in treating insomnia related to the placement of the CPAP. At the same time, Modanafil is used to increase wakefulness, which could persist despite the patient complying with the management of the condition. Surgically, the state could be managed through upper airway surgery to reverse obstruction or through bariatric surgery that enhances weight loss.
Nursing Management
There are various nursing interventions that are required in the management of patients with obstructive sleep apnea. During their visits to the clinic, the nurse is required to provide patients with education regarding their diagnosis and the confirmatory tests required. It is paramount that the nurse articulates the possible adverse effects of the management and answers the patient’s questions to allay anxiety. Once a patient is diagnosed with the condition, the nursing management includes educating them about using the full-face or nasal mask based on the physician’s recommendations.
The nursing management also includes the preparation of the patient for various procedures that could be prescribed for the management of obstructive sleep apnea. The nurse prepares the patient for surgical procedures aimed at reducing the obstruction of the airway. These preparations could include patient education, provision of the premedication, and management of the surgical site to prevent infection.
The nursing management also includes planning for the regular follow-ups, as is the case with other chronic conditions. The nurse should also provide patients with an education geared towards promoting behavioral changes that could encourage better sleeping at night through weight loss to lowering the AHI. Other behavioral interventions could include position therapy, such as educating the patients on the sleep positions they should adopt to enhance airy patency during sleep (Carlucci et al., 2013).
Application to Nursing Practice
The information provided in the article applies to the nursing practice since the nurses are also included in the team managing patients with obstructive sleep apnea. The information provided serves to enlighten the nurse on the causal factors and the physiology of the condition, which is critical in addressing issues that the patient may raise in the education sessions. The provision of information on the possible adverse effects of the various management options provided is also significant to the nursing profession as it allows the nurses to prepare their patients adequately for the management and to plan on how to address the issues that may arise. The management provided in the article contributes towards increasing the utilization of evidence-based care in nursing and hence adds to the quality of care offered within the profession. The report also provides information that could be useful in informing nursing research as it contributes to an understanding of the management of obstructive sleep apnea.
References
Carlucci, M., Smith, M., & Corbridge, S. (2013). Poor sleep, hazardous breathing. An overview of obstructive sleep apnea. The Nurse Practitioner, 38(3), 21-28. Web.
Drager, L. F., Togeiro, S. M., Polotsky, V. Y., & Lorenzi-Filho, G. (2013). Obstructive sleep apnea. Journal of the American College of Cardiology, 62(7), 569-576.
Pedrosa, R. P., Drager, L. F., Gonzaga, C. C., Sousa, M. G., de Paula, L. K., Amaro, A. C.,… & Lorenzi-Filho, G. (2011). Obstructive Sleep Apnea. Hypertension, 58(5), 811-817.