Surgical treatment of obstructive sleep apnea

AORN Journal,  Sept, 2005  by Wayne Colin,  Susan Duval

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The article "Surgical treatment of obstructive sleep apnea" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, BC, education program professional, Center for Perioperative Education.

Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is Sept 30, 2008.

Complete the examination answer sheet and learner evaluation found on pages 395-396 and mail with appropriate fee to

AORN Customer Service

c/o Home Study Program

2170 S Parker Rd, Suite 300

Denver, CO 80231-5711

or fax the information with a credit card number to (303) 750-3212.

You also may access this Home Study via AORN Online at http://www.aorn.org/journal/homestudy/default.htm.

BEHAVIORAL OBJECTIVES

After reading and studying the article on surgical treatment of obstructive sleep apnea, nurses will be able to

1. identify the symptoms of obstructive sleep apnea (OSA),

2. describe continuous positive airway pressure (CPAP) treatment for OSA,

3. discuss reasons for CPAP failure,

4. discuss perioperative nursing care appropriate for patients undergoing surgical treatment of OSA, and

5. explain integrated soft tissue and bone surgical techniques available to treat OSA.

AORN Home Study

This program meets criteria for CNOR and CRNFA recertification, as well as other continuing education requirements.

A minimum score of 70% on the multiple-choice examination is necessary to earn 3.5 contact hours for this independent study.

Purpose/Goal: To educate perioperative nurses about integrated soft tissue and bone surgical techniques available to treat obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a life-threatening and often debilitating disease. It occurs when the upper airway collapses during sleep, producing a mechanical obstruction. When a person is awake, the muscles of the throat keep the airway open (Figure 1). When a person is asleep, these muscles relax, sag inward, and may block respiration (Figure 2). Repeated nocturnal respiratory obstructive episodes lead to poor sleep quality that is physiologically stressful and promotes cardiovascular disease.

[FIGURES 1-2 OMITTED]

Continuous positive airway pressure (CPAP) therapy has been the primary treatment for OSA, but many patients reject this form of therapy. Integrated soft tissue and bone surgery may be a viable alternative for patients who have excluded CPAP as an acceptable option for treating OSA.

SIGNS AND SYMPTOMS OF OBSTRUCTIVE SLEEP APNEA

Obstructive sleep apnea presents as repetitive nighttime blockage of breathing, typically by obstruction at one or more levels of the upper airway, such as the nose, palate, tonsils, or tongue base. (1) The response to upper airway occlusion is a lightened depth of sleep, followed by arousal from sleep, which improves muscle tone and airway patency at the expense of deep, refreshing sleep. (2,3) Chronic intermittent nocturnal airway obstruction can cause repetitive bouts of hypoxia, (4) heightened peripheral vascular constriction, (5) and tachycardic-bradycardic (6) events during sleep.

Obstructive sleep apnea presents with a range of physical signs and symptoms. Loud snoring and witnessed episodes of apnea are clear indicators of airway collapse consistent with OSA and should prompt investigation. Daytime sleepiness, morning headaches, depression, obesity, and fatigue all suggest a need for further evaluation for OSA. (7)

RISK FACTORS

People of any age group and either gender can be afflicted with this common ailment. Patients at high risk for obstructive sleep apnea are those who are morbidly obese, especially patients whose neck size is 17 inches or greater or who have structural abnormalities. Approximately one-third of patients with OSA are not obese/however, which indicates that anatomical disproportion (eg, small jaw, large tongue) also can cause airway occlusion. Estimates show that 24% of men and 9% of women 30 to 60 years of age have OSA. (8) Men over age 40 are at particular risk. Recent information demonstrates that at least two-thirds of postmenopausal women have OSA. (9)

ADVERSE EFFECTS OF OSA

Many adverse cardiovascular health effects are associated with, and possibly caused by, the physiological stresses of OSA, which results in increased risk of premature mortality. (10,11) Several studies have found an increased risk of hypertension in proportion to the intensity of OSA. (12,13) Patients who have an established diagnosis of hypertension should be vigilant for OSA; 83% of a cohort of people on three or more antihypertensive medications have been shown to have OSA. (14) The incidence of coronary artery disease (15) and recurrent heart attack are increased in patients with untreated OSA. (16) This may be a result of recurrent episodes of oxygen desaturation. (17) Furthermore, OSA appears to be a risk factor for both congestive heart failure and stroke. (18)