Early Identification of Obstructive Sleep Apnea and Prevention of Long Term Health Risks Becky Ellis, RN, BSN

Definition Obstructive Sleep Apnea (OSA) is disordered breathing during sleep in which the airway is mechanically obstructed causing a cessation of breathing. Left untreated can lead to cardiovascular and cerebrovascular disease and injury from vehicular accidents because of sleepiness.

Not everyone who snores has sleep apnea, but everyone with sleep apnea snores.

Incidence of Obstructive Sleep Apnea It is estimated that 18 million Americans suffer from OSA Found across all age groups, both sexes, all socioeconomic classes and ethnic groups Most common in obese middle-aged men and obese postmenopausal women

Causes Mechanical obstruction of the airway – BMI (body mass index) of 30 or above – Excessive tissue in neck area – Aging process which causes the neck muscles loose tone and collapse when lying supine

Unobstructed Airway

Obstructed Airway

Pathophysiology Periods when all breathing ceases for up to 30 seconds or longer causing: – Severe oxygen desaturation – Vasoconstriction and consequent increases in systemic pressure, increased left ventricular after load and breathing related changes in cardiac output – Hypoxemia and retention of CO2 activate the chemorelfexes and cause arousal from sleep forcing the person to breathe.

Neurologic Symptoms Irritability Depression Poor judgment Day time hypersomnia – Vehicular Accidents – Occupational accidents

Physiologic Complications Hypertension Left Ventricular Failure Ischemic Heart Disease Severe Sinus Bradycardia Cerebrovascular Disease

Diagnosis Overnight Polysomnography

Treatment Mechanical therapy – CPAP (most common) – Dental appliances that reposition the lower jaw and the tongue – Surgery Uvulopalatopharyngoplasty (UPPP) better results seen in younger patients – Laser-assisted uvulopalatoplasty laser used to remove excess tissue from back of the throat – Tracheostomy used only in sever life threatening cases

Epidemiological Framework Web of Causation – Several risk factors (age, sex, and BMI) – Individuals with two or more risk factors will show an increased predisposition to OSA – Using this framework as the basis for my study middle aged overweight men and overweight postmenopausal women are identified as the group with significant risk

At Risk Population Middle aged overweight men and overweight postmenopausal women residing within the Greater Clark County area.

Further Classification of At Risk Population Those with a history of self or spouse reported snoring Those with a history of hypertension, LVF, cardiac arrhythmias and stroke.

Objectives Widespread public awareness will lead to an 80% increase of newly diagnosed cases of OSA within Clark County over the next 24 months With the initiation of early therapy, morbidity and mortality rates due to related cardiovascular disease in the at risk population will be reduced in Clark County by 60% within the next 48 months.

Goals Increase public awareness of the seriousness of untreated OSA Begin immediately to have employer sponsored classes in the community to educate the public on recognizing, preventing and treating OSA

Plan of Action Begin by educating the health care community particularly those who provide services to the aging population within Clark County Educate the public – Initiate a massive media campaign using public service announcements on selected radio and TV stations – Distribute information pamphlets to health clinics, employers, and senior centers.

References National Institutes of Health (2003). Facts about sleep apnea. Retrieved November 22, 2003, Shamsuzzman, A. S., Gersh, B. J., & Somers, V. K. (2003, October 8). Obstructive sleep apnea. Journal of the American Medical Association, 290, Retrieved November 20, ProQuest Wolk, R. Kara, T. & Somers, V. K. (2003, July 8). Sleep-disordered breathing and cardiovascular disease. Circulation, 108, Retrieved November 19, 2003, ProQuest Young, T. Shahar, E. Nieto, F. J., Redline, S. Newman, A. B., Gottlieb, D. J., Walsleben, J. A., Finn, L. & Enright, P. (2002, April 22). Predictors of sleep-disordered breathing in community-dwelling adults. Archives of Internal Medicine, 162, Retrieved November 15, 2003, ProQuest healthypeople.org. Healthy People Retrieved November 17, 2003, ProQuest