Sleep apnea

Sleep Apnea Nursing Care Plans Diagnosis and Interventions

Sleep Apnea NCLEX Review Care Plans

Nursing Study Guide on Sleep Apnea

Sleep apnea is a sleep disorder characterized by abnormal breathing patterns during sleep. It causes multiple breaks in breathing which can affect the oxygen supply and quality of sleep.

Sleep apnea is a common sleep disorder affecting both genders and people of all ages.

Types of Sleep Apnea

There are three main types of sleep apnea depending on the cause:

  1. Obstructive sleep apnea (OSA) – this occurs when there is an occlusion in the airway, typically due to relaxed throat muscles. The obstruction causes multiple lapses in breathing. 
  2. Central sleep apnea (CSA) – this involves a problem in brain function that can cause lapses in breathing, resulting in slow and shallow breaths.
  3. Mixed sleep apnea – refers to the combination of OSA and CSA, which may also occur at the same time.

Signs and Symptoms of Sleep Apnea

The different types of sleep apnea share similar signs and symptoms. Most symptoms of sleep apnea are left unnoticed by the affected individual, unless pointed out by another person. The most common signs and symptoms are as follows:

  • Loud snoring – it may include gasping or choking, which may briefly wake the person up
  • Episodes of pauses in breathing as reported by another person
  • Gasping for air when sleeping
  • Waking up with a dry mouth
  • Headaches in the morning
  • Insomnia or difficulty sleeping and staying asleep
  • Hypersomnia or excessive daytime sleepiness
  • Issues with attention span or difficulty thinking clearly
  • Irritability
  • Nocturia or frequent urination at night

Causes of Sleep Apnea

Obstructive sleep apnea (OSA), which occurs when the airway is blocked during sleep, has the following common causes:

  • Anatomical reasons – The size of the person’s neck, jaw, tongue, tonsils, and surrounding organs can block airflow.
  • Obesity – obesity is noted in about 60% of cases of sleep apnea. It contributes to the narrowing of the airway causing airflow problems.
  • Sedatives including alcohol use – alcohol and sedatives can relax the muscles of the throat which can directly obstruct airflow.
  • Family history – having close relatives with sleep apnea increases the risk of developing the disorder.
  • Cigarette smoking – heavy smokers are known to have a higher risk of developing the condition.
  • Sleeping in supine position – sleeping on one’s back increases the chances of throat muscles to relax and obstruct the airway.
  • Nasal congestion – a reduced ability to breathe through the nose is known to increase the chances of having sleep apnea.
  • Hormonal imbalance – some endocrine conditions such as hypothyroidism and acromegaly can cause tissues around the neck to swell and cause blockage to the airway.

Central sleep apnea CSA) is commonly related to a medical condition, such as the following:

Complications of Sleep Apnea

  1. Fatigue. The reduced quality of sleep can easily affect the ability to function during the day. It can cause inadequate energy, irritability, and daytime drowsiness which can affect the performance of activities of daily living.
  2. High blood pressure and/or heart problems. A drop in the blood oxygen level when sleep apnea occurs can trigger the body to compensate by increasing the blood pressure to deliver more oxygenated blood. This adds strain to heart muscles which increases the risk for heart attack and arrhythmias.
  3. Type 2 diabetes. Sleep apnea is linked to insulin resistance and type 2 diabetes.
  4. Metabolic syndrome. This refers to a condition characterized by hypertension, high cholesterol levels, high blood sugar levels, and increased waist circumference.
  5. Complications from medications and surgery. The breathing problem associated with sleep apnea is a concern for people having surgery and those on certain medications.
  6. Liver conditions. Sleep apnea can affect liver functions and is linked to non-alcoholic fatty liver disease.
  7. Sleep-deprived partners. Those who sleep with a person with sleep apnea are known to have interrupted sleep due to the loud snoring associated with the condition.

Diagnosis of Sleep Apnea

Once sleep apnea is suspected from the reported signs and symptoms, a referral to a sleep disorder center is further completed. A sleep specialist in the center will help with the diagnosis and determine the need for further tests and evaluation.

Diagnosing sleep apnea may involve an overnight stay at the sleep center to monitor breathing while the person is asleep.

  • Nocturnal polysomnography – a machine will be attached to monitor the heart, lungs, brain activity, breathing patterns, arm and leg movements, and blood oxygen levels.
  • Home sleep tests – a kit to monitor heart rate, blood oxygen levels, airflow, and breathing patterns can be taken home to use during sleep.

Treatment of Sleep Apnea

Mild forms of sleep apnea may only require lifestyle changes such as smoking cessation and weight loss.

  1. Air pressure devices and oral appliances. Continuous positive airway pressure (CPAP) is a machine that delivers air through a mask during sleep may be used to maintain airflow. This is a common treatment for sleep apnea; however, some may find the mask straps uncomfortable. Other devices can also be used to deliver air pressure, such as a bilevel positive airway pressure (BiPAP) machine. There are oral appliances can be used to keep the throat open can help prevent airway obstruction.
  2. Treatment of underlying medical problems. Some medical conditions such as hypothyroidism or obesity can cause sleep apnea.
  3. Oxygen supplementation. Additional oxygen supply can be given during sleep to support the body’s oxygen need.
  4. Adaptive servo-ventilation (ASV). This is a newer treatment for sleep apnea that involves the use of an airflow device that records the normal breathing pattern when awake and uses it when the person sleeps.
  5. Surgical interventions:
  • Tissue removal – a surgical procedure called uvulopalatopharyngoplasty involves the removal of some tissues in the airway.
  • Tissue shrinkage – the airway can also be widened through radiofrequency ablation.
  • Repositioning of the jaw – the jaw can be repositioned to lessen the possibility of obstruction.
  • Implants – polyester or plastic rods are implanted in the soft palate to keep the airway open. However, more research is still needed to evaluate its success.
  • Nerve stimulation – this involves the stimulation of the nerve controlling the tongue to avoid airway occlusion.
  • Tracheostomy – an opening on the neck followed by the insertion of a breathing tube may need to be performed in severe cases of sleep apnea.

Nursing Care Plans for Sleep Apnea

Nursing Care Plan 1

Nursing Diagnosis: Ineffective Breathing Pattern related to impaired regulation secondary to sleep apnea as evidenced by breaks in breathing during sleep, pallor, cyanosis, and shallow breathing, decreased oxygen saturation, or changes in respiratory depth

Desired Outcome: The patient will achieve effective breathing pattern as evidenced by respiratory rates between 12 to 20 breaths per minutes, oxygen saturation within the target range, and absence of pallor or cyanosis.

InterventionsRationales
Assess the patient’s vital signs and characteristics of respirations at least every 4 hours.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment.
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within the target range.
Encourage the patient to sleep in a side-lying position and avoid the supine position.sleeping on one’s back increases the chances of throat muscles to relax and obstruct the airway.
Elevate the head of the bed slightly prior to sleep.Head elevation can help prevent airway obstruction and improve the expansion of the lungs, enabling the patient to breathe more effectively even when asleep.
Place the patient on a pulse oximeter and apnea monitor when asleep.To monitor oxygen saturation levels and other vital signs during sleep.
Hook the patient to a continuous positive airway pressure (CPAP) machine, or other devices as prescribed by the sleep specialist.To maintain airflow during sleep.
Administer methyxanthines as prescribed.These medications can relax the smooth muscles and stimulate the cardiac muscles and central nervous system for spontaneous breathing.
With infants, gently rub the soles of the feet or chest wall.To provide tactile stimulation, which can stimulate spontaneous breathing in infants with mild or intermittent episodes of sleep apnea.

Nursing Care Plan 2

Nursing Diagnosis: Impaired Gas Exchange related to altered oxygen supply secondary to sleep apnea as evidenced by apnea, oxygen saturation of 85% (hypoxia) during sleep, heart rate below normal (bradycardia) during sleep

Desired Outcome: The patient will demonstrate adequate oxygenation as evidenced by an oxygen saturation and heart rate within the normal range.

InterventionsRationales
Assess the patient’s vital signs, especially the respiratory rate and depth during sleep. Auscultate the lungs and monitor for wheezing or other abnormal breath sounds.To create a baseline set of observations for the patient, and to monitor any changes in the vital signs as the patient receives medical treatment.
Monitor the color of skin and mucous membrane. Check for any changes in consciousness or presence of irritability and restlessness, especially in infants.Peripheral cyanosis (bluish discoloration of the skin, ear lobes, or nail beds) may be evident with hypoxia. Central cyanosis involving the mucosa may indicate further reduction of oxygen levels.
Changes in the level of consciousness may indicate the state of hypoxia or impaired oxygenation of the brain.
Monitor ABG levels.To consistently check for respiratory function by monitoring the changes in pO2 and pCO2.
Provide humidified oxygen as prescribed.To reduce the risk of drying out the lungs.
Reposition the patient by elevating the head of the bed and encouraging him/her to sleep in a side-lying rather than supine position. Encourage pursed lip breathing and deep breathing exercises during waking hours.To improve the delivery of oxygen in the airways and to reduce shortness of breath and risk for airway collapse.
Refer the patient to a sleep specialist.To enable to patient to receive more information and specialized care in treating sleep apnea and enabling of improved gas exchange.
Hook the patient to a continuous positive airway pressure (CPAP) machine, or other devices as prescribed by the sleep specialist.To maintain airflow during sleep.
Administer methyxanthines as prescribed.These medications can relax the smooth muscles and stimulate the cardiac muscles and central nervous system for spontaneous breathing.

Other possible nursing diagnoses:

  • Sleep Deprivation
  • Compromised Family Coping
  • Risk for Altered Parenting

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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