SLEEP APNEA

AUNI WARDINA BINTI WARODZEE (A188380)

NABILA BINTI MUSTAPA (A187884)
NIK NURHAZLEEN BINTI NIK ZAINAL ABIDIN
(A187233)
NORFAIZA LAINA BINTI JAMA'AN (A188140)
 LIST OF CONTENT

Definition Diagnostic findings

Risk factor Medical and surgical
Etiology management
Pathophysiology Nursing management
Clinical manifestation Nursing process
Complication Health education
 SLEEP APNEA
Sleep apnea is absence of breathing during sleep .
Last for at least 10seconds or longer
Sleep apnea affects men more than women and most commonly in older adults.

Types Of sleep apnea :

Obstructive sleep apnea
(OSA)
More common form that
occurs when throat muscles
relax and the tongue falls
back causes obstructed of
the upper airway.
Central sleep apnea (CSA),
Occurs when the brain doesn't
send proper signals to the
muscles that control
breathing
Mixed sleep apnea,
Occurs when an individual
has both obstructive sleep
apnea(OSA) and central sleep
apnea (CSA)
 RISK FACTOR

Obstructive Sleep Apnea Central Sleep Apnea

Obesity
Older
Neck circumference
Male
Narrowed airway
Heart disease
Male
Using narcotics pain medication
Older adult
Stroke
Family history
Use alcohol, sedatives,tranquilizer
Smoking
Nasal congestion
 ETIOLOGY

Obstructive Sleep Apnea Central Sleep Apnea

Muscles in the back of your Nervous system damage

throat relax too much causing especially brainstem (manages
the surrounding tissue to press your breathing)
on your windpipe. That obstructs
air’s ability to pass through it.
PATHOPHYSIOLOGY
Pharyngeal muscle(located
posterior to the oral cavity): Obstructive Sleep Apnea
muscle that support soft tissue
in throat such as tongue and
Increase the activity of the pharyngeal
soft palate.
dilator muscle and maintain airway
patency
 Central Sleep Apnea

Loss Of neurologic output from the respiratory center of the brain

Lack of drive to breathe during sleep ( Person does

not make any breathing effort)

No respiratory effort.
Insufficient ventilation.
Compromised gas exchange
 CLINICAL MANIFESTATION
Insomnia
Loud snoring/
Morning (Difficulty
episode of
headache staying
apnea
asleep)

Hypersomnia Xerostamia
(Excessive Irritability (Awaken with
daytime dry mouth
sleepiness
 COMPLICATION
Daytime fatigue and sleepiness- lack restorative sleep at night cause a work-
related accident

Hypertension(OSA)and heart problem- sudden drop of oxygen (hypoxia)

cause strain cardiovascular system

Type-2 diabetes (OSA)- increase risk develop insulin resistance

Concentration and impaired memory (OSA)- brain does not have sufficient
time to consolidate memories

Sleep deprived-partner(OSA) - keep anyones sleeps nearby from getting a

good rest
 PHYSICAL EXAMINATION

Examine of the throat, neck, and mouth

Take medical history
Ask about sleep, bedtime routine &
symptoms.
 DIAGNOSTIC FINDINGS
Overnight sleep study
(Polysomnography)
Overnight test
Gold standard diagnose
sleep apnea
Sleep in medical facility
(sleep lab)
Involves sensors that
monitor heart rate,
breathing, blood oxygen
levels, brain waves
Involve components:
1. Electroencephalogr
aphy (EEG)-
measure brain wave
activity
2. Electroculogram
(EOG)- measure eye
movement
3. Electromyography
(EMG)- measure
muscle movement
4. Electrocardiography
(ECG)- record
electrical activity of
heart
Continued... Nasopharyngoscopy

Procedure which a
Home sleep apnea flexible fiberoptic
testing endoscope inserts
through the nose and
Similar as throat
polysomnography but not To observe anatomical
involve brain wave structures that narrow the
monitoring (just measure airway and compromise
SPO2 & HR) airflow causing snoring.
Not option because
cannot diagnose central
sleep apnea
Severity of Obstructive Sleep Apnea
Measurement and rating system : Apnea-Hypopnea Index (AHI)

Measures average number of apnea and hypopnea episodes that experience per hour during
sleep.
 MEDICAL MANAGEMENT
1.Positive Airway Pressure (PAP) Therapy.
a machine that uses mild air pressure to keep breathing
airways open while you sleep.
patient will wear mask over the nose and mouth
provides pressurized air through a mask to help keep your
airway open and keep you breathing.

Types:
i)CPAP(Continuous Positive Airway Pressure) - most wildly
used out of all PAP devices and set at one single pressure.
ii)Bi-Level PAP - uses one pressure during inhalation and
lower pressure during exhalation.
iii) Auto PAP - automatically adjusts the air pressure to
compensate for changes in your sleep position or medications
that may have changed your breathing.
MEDICAL MANAGEMENT
2. Oral Devices
i) Mandibular Repositioning Mouthpieces
-cover the upper and lower teeth and hold
the jaw in a position that prevents it from
blocking the upper airway.

ii) Tongue Retaining Device

-mouthpieces that hold the tongue in a
forward position to prevent it from blocking
the upper airway.
 SURGICAL MANAGEMENT
1. Tissue Removal (Uvulopalatopharyngoplasty)
removal of tissue from the rear of your mouth and
top of the throat.
tonsils and adenoids usually are removed as well.

2. Tissue Shrinkage (Somnoplasty)

minimally invasive procedure to reduce soft tissue at
at the rear of the mouth and back of the throat using
radiofrequency ablation.
used for mild to moderate sleep apnea.

3. Jaw Repositioning (maxillomandibular advancement)

jaw is moved forward from the remainder of the face
bones.
enlarges the space behind the tongue and soft palate.
SURGICAL MANAGEMENT
4. Hypoglossal Nerve Stimulator
requires surgery to insert a stimulator for the
nerve that controls tongue movement
(hypoglossal nerve).
implanted under the skin on right side of the
chest with electrodes that connects to the
hypoglossal nerve in the neck to the intercostal
muscle in the chest.
the device will be turned on at bedtime with a
remote control where the hypoglossal nerve will
be stimulated with each breath.
increased stimulation helps keep the tongue in a
position that keeps the airway open.
NURSING MANAGEMENT(PRE-OPERATIVE)

.
Assess patient history such as underlying disease,
medications and allergies.
Monitor vital signs such as blood pressure, temperature, pulse
rate and SpO2 for baseline data before surgery.
Ask patient to not take anticoagulant medications such as
heparin and warfarin at least 2 weeks before surgery to avoid
bleeding.
Ask patient to Nil By Mouth(NBM) at least 6 hours before
surgery to prevent pulmonary aspiration of stomach contents.
Ask for consent from patient. It is important for patient to
know information regarding the procedure.
NURSING MANAGEMENT(POST-OPERATIVE)

Managing patient's pain by giving medications such as

opioids(Morphine, Tramadol).
Monitor vital signs such as blood pressure, temperature,
pulse rate and SpO2 for baseline data after surgery.
Position patient appropriately and ensure patient's
safety(place call bell within reach, raise side rails).
Monitor for signs of allergic reaction.
Assess surgical site for signs of bleeding or infection.
Monitor fluid balance to ensure patient is hydrated.
NURSING DIAGNOSIS
ND 1: Ineffective breathing pattern related to narrowing of respiratory passages as manifested by episode of
apnea, and snoring.
Desired outcome: Patient will maintain effective breathing pattern with decreased snoring and apneic
episodes.

Nursing Interventions Rationale

Assess for characteristics of sleep-disordered

breathing (SDB): loud snoring, and severity of apneic To assist in creating the best interventions for the patient.
using Apnea-Hypopnea Index (AHI)

Encourage the patient to sleep in lateral, prone or semi-

To avoid the throat muscles to relax and occlude the airway.
prone position and avoid recumbent/supine position

Hook the patient to a continuous positive airway

To maintain the airway and patency.
pressure (CPAP) machine

Administer supplemental oxygen as prescribed by the To raise oxygen level and achieve an SpO2 value within the
physician target range (above 95%).

Encourage the patient to use oral appliances such as

mandibular repositioning mouthpiece and tongue To keep the throat open and help prevent airway obstruction.
retaining device
ND 2: Disturbed sleeping pattern related to ineffective breathing pattern as manifested by verbal complaints
about interrupted sleep.
Desired outcome: Patient will verbalize feeling rested and having an improved sleeping pattern.

Nursing Interventions Rationale

Assess the patient's vital signs especially the

To create a baseline data and as a guideline to create nursing
respiratory rate and depth during sleep. Auscultate the
interventions.
lungs and monitor for any abnormal breath sounds.

Reposition the patient to sleep in lateral, prone or semi-

To reduce risk for airway collapse.
prone rather than supine/recumbent position.

Encourage pursed lip breathing and deep breathing To improve delivery of oxygen in the airways and to reduce
exercises during waking hours shortness of breath.

Hook the patient to continuous positive airway pressure

To maintain airflow during sleep
(CPAP) machine.

To enable the patient to gain more information and specialized

Collaborate with sleep specialist to treat sleep apnea
care in treating sleep apnea.
ND 3: Fatigue related to inadequate amount of sleep as manifested by a persistent sense of tiredness.
Desired outcome: Patient will enhance their energy level.

Nursing Interventions Rationale

Assess severity and frequency of fatigue, ability to

To create a baseline data and as a guideline to create nursing
perform ADLs, ability to concentrate, mood and typical
interventions
sleep cycles.

Assist the patient in setting a daily exercise and rest To help the patient complete desired activities while reducing
regimen. Discuss the need to take frequent breaks. fatigue levels.

Support the patient in prioritizing preferred activities To allow the patient to use the energy available to fulfill vital
and daily tasks. tasks.

Encourage adequate nutritional intake to the patient. To promote adequate sleep and avoid fatigue.

Assist the patient in developing behaviors that

encourage healthy rest or sleep patterns such as avoid To help restore energy, avoid fatigue, and prevent the
alcohol intake few hours before bed time and the right acquisition of sleep disorders.
position to sleep.
ND 4: Risk for anxiety related to changes in health status.
Desired outcome: Patient will reduce the anxiety level.

Nursing Interventions Rationale

Assess and acknowledge presence of anxiety: increased in

To have a baseline data to create the best nursing
blood pressure and pulse rate, sign of isolation, change of
interventions.
speech in terms of the rate of speech, and restlessness

To develop a trusting therapeutic relationship and make the

Provide active-listening to patient
patient feel heard.

Give clear explanation about sleep apnea and the management To help patient deals with the situation effectively, which
to the patient lowers anxiety and fear of the unknown.

Educate patient on relaxation techniques, such as deep

To reduce the anxiety and provide calmness.
breathing exercises.

Encourage the patient to practice positive self talk To build up a healthy mindset.
ND 5: Risk for bleeding related to surgical incision.
Desired outcome: Patient will remain free from bleeding during hospitalization.

Nursing Interventions Rationale

Monitor vital signs, especially blood pressure and heart To identify bleeding. Hypotension and tachycardia are initial
rate. compensatory mechanisms usually noted with bleeding.

Monitor patient's blood investigation: coagulation Decreased hemoglobin and hematocrit may be early indicator
profile, hematocrit and hemoglobin levels. of bleeding.

Assess patient's surgical wound site and note for any

To identify early sign of bleeding.
increased in tenderness, bruising and bleeding

Administer blood products if indicated To replace blood clotting factors.

 Weight loss and
Avoid alcohol
exercise

HEALTH
Usage of
EDUCATION Avoid hypnotics
continuous and
positive airway antihistamines
pressure (CPAP)

Sleep position
 References
A. D. Linton, M. A. Matteson. 2020. MEDICAL-SURGICAL NURSING,
SEVENTH EDITION.
Hinkle, J. L., Cheever, K. H., & Hinkle, J. L. 2018. Brunner & Suddarth's
textbook of Medical-Surgical Nursing: Wolters Kluwer.
Betty J. Ackley, MSN, EdS, RN Gail B. Ladwig, MSN, RN Mary Beth Flynn
Makic, PHD, RN, CCNS, FAAN, FNAP Marina Reyna Martinez-kratz, MS,
RN, CNE Melody Zanotti, BA, RN, LSW. Revised reprint 2022. Nursing
Diagnosis Handbook An Evidence-Based Guide to Planning Care twelfth
edition.
Sleep apnea - Symptoms and causes. (2023, April 6). Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/sleep-
apnea/symptoms-causes/syc-20377631
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