Sleep Apnea: Overview and Practice Questions (2024)

Sleep apnea is a common but serious sleep disorder characterized by repeated interruptions in breathing during sleep.

These interruptions, known as periods of apnea, can last from a few seconds to a minute and often result in poor sleep quality and a range of health complications.

Understanding the types, symptoms, risk factors, and treatments of sleep apnea is crucial for recognizing and managing this condition effectively.

What is Sleep Apnea?

Sleep apnea is a sleep disorder characterized by repeated interruptions in breathing for 10 seconds or longer. These pauses can occur multiple times during the night, leading to poor sleep quality and daytime fatigue. It can result from obstructed airways (obstructive sleep apnea) or brain signaling issues (central sleep apnea).

Types of Sleep Apnea

There are three main types of sleep apnea:

1. Obstructive Sleep Apnea (OSA)
2. Central Sleep Apnea (CSA)
3. Complex Sleep Apnea (CompSAS)

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is the most common type of sleep apnea. It occurs when the muscles at the back of the throat relax excessively during sleep, causing a temporary obstruction of the airway.

This obstruction leads to repeated episodes of breathing cessation, known as apneas, which can last from a few seconds to a minute. These episodes often result in a decrease in blood oxygen levels and can cause the person to wake up briefly to resume breathing.

Common symptoms of OSA include loud snoring, gasping or choking during sleep, excessive daytime sleepiness, and morning headaches. Risk factors include obesity, a large neck circumference, and anatomical variations in the airway.

Central Sleep Apnea

Central sleep apnea (CSA) is less common and is characterized by a failure of the brain to send the appropriate signals to the muscles that control breathing. Unlike OSA, where the issue is a physical blockage of the airway, CSA involves a lack of respiratory effort.

This type of sleep apnea is often associated with underlying medical conditions such as heart failure, stroke, or other conditions affecting the brainstem.

Symptoms of CSA can include episodes of stopped breathing, sudden awakenings with shortness of breath, difficulty staying asleep, and daytime fatigue. CSA can be more challenging to treat due to its neurological origin.

Complex Sleep Apnea

Complex sleep apnea syndrome (CompSAS) is a condition where individuals who are being treated for obstructive sleep apnea with CPAP therapy develop central sleep apnea.

In CompSAS, the initial obstructive apneas are effectively managed with CPAP, but central apneas emerge during treatment. This type of sleep apnea involves a combination of both obstructive and central mechanisms.

Symptoms of CompSAS may include those associated with both OSA and CSA, such as loud snoring, episodes of breathing cessation, daytime sleepiness, and difficulty maintaining sleep.

Management often requires specialized approaches, including adjustments to CPAP settings or the use of adaptive servo-ventilation (ASV) devices.

Sleep Apnea Risk Factors

Several risk factors can contribute to the development of sleep apnea, including the following:

• Obesity: Excess body weight is a significant risk factor for sleep apnea, especially obstructive sleep apnea (OSA). Fat deposits around the upper airway can obstruct breathing, increasing the likelihood of airway collapse during sleep.
• Neck Circumference: A larger neck circumference (greater than 17 inches in men and 16 inches in women) can indicate excess tissue around the airway, which can obstruct breathing.
• Age: Sleep apnea is more common in older adults. The risk increases with age, particularly in individuals over 40.
• Gender: Men are more likely to develop sleep apnea than women. However, the risk for women increases after menopause. Hormonal differences may influence airway stability and muscle tone.
• Family History: A family history of sleep apnea increases the likelihood of developing the condition. Genetic factors may influence airway structure and muscle control.
• Use of Alcohol, Sedatives, or Tranquilizers: These substances relax the muscles in the throat, increasing the risk of airway obstruction during sleep.
• Smoking: Smoking increases the risk of sleep apnea by causing inflammation and fluid retention in the upper airway. Smokers are more likely to develop OSA than non-smokers.
• Nasal Congestion: Chronic nasal congestion can increase the risk of sleep apnea, regardless of its cause (allergies, sinus problems, etc.). Difficulty breathing through the nose can lead to mouth breathing and airway obstruction.
• Medical Conditions: Conditions such as hypertension, heart disease, type 2 diabetes, and stroke are associated with a higher risk of sleep apnea. These conditions can contribute to or exacerbate the mechanisms that lead to sleep apnea.
• Anatomical Features: Certain anatomical features, such as a narrow airway, large tonsils, a large tongue, or a small jaw, can predispose individuals to OSA.
• Polycystic Ovary Syndrome (PCOS): This condition is associated with obesity and hormonal imbalances, which can increase the risk of sleep apnea.
• Pregnancy: Pregnancy can increase the risk of sleep apnea due to weight gain and hormonal changes that affect breathing patterns. Pregnant women, especially in the third trimester, may experience OSA symptoms.

By recognizing these risk factors, individuals can take proactive steps to reduce their risk of sleep apnea, such as maintaining a healthy weight, avoiding smoking and excessive alcohol use, and managing underlying medical conditions effectively.

If risk factors are present, seeking evaluation and possible intervention from a healthcare provider is essential.

Sleep Apnea Symptoms

Sleep apnea is characterized by a range of symptoms that can vary in severity. The primary symptoms include:

• Loud Snoring: Persistent and loud snoring is one of the most common symptoms of Obstructive Sleep Apnea (OSA). The snoring results from the partial obstruction of the airway during sleep.
• Episodes of Breathing Cessation: Repeated pauses in breathing during sleep, often noticed by a bed partner. These episodes, known as apneas, can last from a few seconds to a minute or more.
• Gasping or Choking During Sleep: Sudden awakenings accompanied by gasping or choking, as the body reacts to the lack of oxygen and attempts to reopen the airway.
• Excessive Daytime Sleepiness: Feeling excessively sleepy during the day, even after a full night’s sleep. This symptom is due to the frequent interruptions in sleep quality caused by apneas.
• Morning Headache: Waking up with a headache, which is often due to changes in oxygen and carbon dioxide levels in the blood during apneas.
• Difficulty Concentrating: Trouble focusing, remembering things, or maintaining attention during the day, often related to the poor quality of sleep.
• Irritability or Mood Changes: Increased irritability, mood swings, or symptoms of depression, which can result from chronic sleep deprivation.
• Dry Mouth or Sore Throat Upon Waking: Waking up with a dry mouth or sore throat, typically caused by breathing through the mouth during sleep.
• Frequent Nighttime Urination (Nocturia): Waking up frequently during the night to urinate. This can be a result of the body’s response to the breathing pauses during sleep.
• Insomnia: Difficulty falling asleep or staying asleep, often due to the frequent awakenings caused by apneas.
• Restless Sleep: Frequent tossing and turning during the night, with an overall feeling of restlessness.
• Witnessed Apneas: Observations by a bed partner of periodic pauses in breathing during sleep.
• Night Sweats: Excessive sweating during sleep, which can be a reaction to the stress of struggling to breathe.

Note: Recognizing these symptoms can help in identifying sleep apnea and seeking appropriate medical evaluation and treatment to improve sleep quality and overall health.

Sleep Apnea Diagnosis

Diagnosing sleep apnea involves a comprehensive evaluation by a healthcare provider, often a sleep specialist.

The process typically includes the following steps:

• Medical History and Symptom Review: The healthcare provider will take a detailed medical history and review the symptoms. This includes asking about sleep habits, daytime sleepiness, snoring, and any observed apneas or gasping during sleep. The provider may also inquire about risk factors such as obesity, family history, and lifestyle factors.
• Physical Examination: A physical exam may be conducted to check for anatomical features that might contribute to sleep apnea, such as large tonsils, a large neck circumference, or nasal obstruction. The provider may also check for signs of other medical conditions related to sleep apnea, such as high blood pressure.
• Questionnaires and Sleep Diaries: Patients may be asked to complete questionnaires that assess the severity of sleepiness and the impact of sleep apnea on daily life. Common questionnaires include the Epworth Sleepiness Scale and the Berlin Questionnaire. Keeping a sleep diary for one to two weeks can provide additional insight into sleep patterns and symptoms.
• Polysomnography (Sleep Study): Polysomnography is the gold standard for diagnosing sleep apnea. It is an overnight sleep study conducted in a sleep lab, where various body functions are monitored while the patient sleeps. These functions include brain activity, eye movements, muscle activity, heart rate and rhythm, respiratory effort and airflow, blood oxygen levels, body position, and limb movements.
• Home Sleep Apnea Testing (HSAT): For some patients, a home sleep apnea test (HSAT) may be an alternative to in-lab polysomnography. HSAT involves using portable monitoring devices that measure airflow, breathing patterns, oxygen levels, and heart rate during sleep at home. While not as comprehensive as in-lab studies, HSAT can be convenient and cost-effective for diagnosing moderate to severe obstructive sleep apnea.
• Evaluation of Coexisting Conditions: The healthcare provider will also assess for other medical conditions that might coexist with or exacerbate sleep apnea, such as hypertension, diabetes, heart disease, or chronic respiratory disorders.
• Follow-Up and Interpretation: After the sleep study, the results are reviewed by the sleep specialist. The number of apnea and hypopnea events per hour of sleep (apnea-hypopnea index, AHI) is used to diagnose and determine the severity of sleep apnea. Mild has an AHI of 5-15 events per hour, moderate has an AHI of 15-30 events per hour, and severe has an AHI of more than 30 events per hour. The interpretation of the results guides the treatment plan and management strategies.
• Consultation and Treatment Planning: Based on the diagnosis, the healthcare provider will discuss treatment options, which may include lifestyle changes, Continuous Positive Airway Pressure (CPAP) therapy, oral appliances, or surgery. The treatment plan is tailored to the patient’s specific condition, severity of sleep apnea, and individual needs.

Note: Accurate diagnosis of sleep apnea is crucial for effective treatment and management, improving sleep quality, overall health, and quality of life for affected individuals.

Sleep Apnea Treatment

Treating sleep apnea involves a combination of lifestyle changes, medical interventions, and sometimes surgical options. The goal is to keep the airway open during sleep and ensure uninterrupted breathing.

Here are the primary treatment options for sleep apnea:

• Lifestyle Changes: Losing weight, regular exercise, sleeping on the side, avoiding alcohol and sedatives, and quitting smoking can significantly reduce sleep apnea symptoms and improve overall health.
• Continuous Positive Airway Pressure (CPAP): CPAP therapy involves wearing a mask connected to a machine that delivers a continuous stream of air to keep the airway open, effectively reducing symptoms and improving sleep quality.
• Bi-Level Positive Airway Pressure (BiPAP): Similar to CPAP, BiPAP delivers two levels of air pressure (higher for inhalation, lower for exhalation), providing a more comfortable experience for some patients and is often used for those with central sleep apnea or COPD.
• Adaptive Servo-Ventilation (ASV): ASV adjusts air pressure based on breathing patterns, making it effective for treating complex and central sleep apnea by stabilizing breathing.
• Oral Appliances: Custom-made devices worn during sleep to reposition the jaw or tongue, keeping the throat open. Suitable for mild to moderate OSA or for patients who cannot tolerate CPAP.
• Surgery: Options include uvulopalatopharyngoplasty (UPPP), genioglossus advancement (GA), maxillomandibular advancement (MMA), and Inspire Therapy. Surgery is considered when other treatments fail or are not suitable, with varying effectiveness.
• Positional Therapy: Encourages sleeping in a position that prevents airway obstruction, such as sleeping on the side. This can be facilitated by special pillows, wearable devices, or alarms.
• Medication: While not a primary treatment, medications like nasal decongestants or those for central sleep apnea may be prescribed to address underlying conditions or symptoms, typically in conjunction with other treatments.
• Supplemental Oxygen: Prescribed in some cases, especially with central sleep apnea, to ensure adequate oxygen levels during sleep. Oxygen can be administered through concentrators or portable tanks.
• Behavioral Therapy: Cognitive-behavioral therapy (CBT) for insomnia (CBT-I) can help address sleep hygiene and behaviors contributing to sleep apnea symptoms. This helps develop better sleep habits and manage anxiety or stress that may exacerbate sleep apnea.

Note: Choosing the appropriate treatment for sleep apnea depends on the type and severity of the condition, patient preferences, and any underlying health issues.

Sleep Apnea Practice Questions

1. What is a condition in which an individual stops breathing while asleep, causing a measurable decrease in blood oxygen levels?
Sleep apnea

2. What are the two main types of sleep apnea?
Obstructive sleep apnea and central sleep apnea

3. Which type of sleep apnea is caused by a blockage in the air passage due to relaxed airway muscles allowing the tongue and palate to block the airway?
Obstructive sleep apnea

4. Which type of sleep apnea is caused by a disorder in the respiratory control center of the brain?
Central sleep apnea

5. What factors increase the severity of sleep apnea and make it more common in men?
Obesity, hypertension, smoking, alcohol ingestion, and the use of sedatives

6. How is sleep apnea diagnosed?
When more than five periods of apnea, each lasting at least 10 seconds, occur during one hour of sleep

7. What effect do apnea periods have on blood oxygen levels?
They reduce the blood oxygen level.

8. What happens to an individual during an apnea event?
The brain awakens the individual, who then gasps for air and snores loudly.

9. What are the daytime consequences of sleep apnea?
Excessive tiredness and drowsiness

10. What are some treatment options for mild sleep apnea?
Losing weight, abstaining from smoking and the use of alcohol or sedatives, and sleeping on the side or stomach

11. How can an oral appliance help in the treatment of sleep apnea?
By maintaining airway patency if worn while sleeping

12. What device is used in more severe cases of obstructive sleep apnea to keep the airway open during sleep?
Continuous positive airway pressure (CPAP)

13. What components make up the CPAP device?
A mask fit securely against the face and tubing connected to a blower device

14. What surgical options are available if CPAP and other treatments are ineffective?
Maxillomandibular advancement surgery (MMA) and uvulopalatopharyngoplasty (UPPP)

15. What extreme measure might be taken in severe life-threatening cases of sleep apnea?
A tracheostomy (surgical opening in the neck)

16. What is the usual treatment for central sleep apnea?
Medications to stimulate breathing

17. What is the most common sleep-related breathing disorder that causes you to repeatedly stop and start breathing while you sleep?
Obstructive sleep apnea (OSA)

18. The most effective treatments for sleep apnea include all of the following EXCEPT:
The use of stimulant drugs.

19. Sleep apnea would be diagnosed in a patient who has which of these findings?
During a sleep study, obstructive sleep apnea (OSA) is confirmed when either of the following two conditions exists: 15 or more apneas, hypopneas, or RERAs per hour of sleep (i.e., the AHI or RDI >15 events/hour) in an asymptomatic patient. More than 75% of the apneas and hypopneas must be obstructive. Or, 5 or more apneas, hypopneas, or RERAs per hour of sleep (i.e., the AHI or RDI >5/hour events/hour) in patients with symptoms (e.g., sleepiness, fatigue, and inattention) or signs of disturbed sleep (e.g., snoring, restless sleep, and respiratory pauses). More than 75% of the apneas and hypopneas must be obstructive.

20. Signs and symptoms of sleep apnea include which of the following?
Loud snoring

21. What is the rationale for using CPAP to treat sleep apnea?
Positive air pressure holds the airway open

22. A 64-year-old obese man is admitted to the hospital for treatment of heart failure secondary to alcoholism. For which of the following negative consequences should you assess?
Obstructive sleep apnea: Factors associated with increased risk for OSA include obesity, diabetes, stroke, Parkinson’s disease, congestive heart failure, genetic predisposition, craniofacial anatomic features, and the use of alcohol or medications that depress the respiratory center.

23. Which problem is associated with obesity, heavy snoring, and shallow breathing?
Sleep apnea

24. A 45-year-old obese man has complaints of daytime sleepiness, difficulty going to sleep at night, and snoring. What is the patient exhibiting manifestation of?
Obstructive sleep apnea

25. A patient with severe sleep apnea has been prescribed continuous positive airway pressure (CPAP). A respiratory therapist adjusts the blower to maintain adequate positive pressure during inspiration and expiration. The respiratory therapist should maintain the pressure in what range?
The pressure required to maintain an adequate positive pressure is 5-25 cm of H2O. This range of pressure is essential to avoid collapse of the airway.

26. A patient’s partner informs the respiratory therapist that the patient wakes up with a startle and gasps for breath several times at night. The respiratory therapist understands the patient is experiencing sleep apnea. What are the common risk factors in this patient for sleep apnea?
The common risk factors for sleep apnea include a BMI greater than 28 kg/m2, a smoking habit, and a neck circumference greater than 17 inches. Sleep apnea is often observed in patients older than 65 years. Occasional consumption of alcohol is not a risk factor by itself.

27. A patient with sleep apnea asks the respiratory therapist, “What can I do to get better sleep?” What is an appropriate response?
“Being overweight is a contributing factor; losing weight can often resolve apnea.”

28. A patient with obstructive sleep apnea tells the respiratory therapist, “I just hate using this continuous positive airway pressure (CPAP) thing, but I know I need it. Is there anything I can do so that I don’t need to use it?” Which of these would be an appropriate suggestion?
Referral to a weight loss program.

29. A patient with sleep apnea is scheduled for surgery that involves excision of the tonsillar pillars, uvula, and posterior soft palate to remove the obstructing tissue. What is this surgery called?
Uvulopalatopharyngoplasty

30. The respiratory therapist is caring for a middle-aged man who complains of excessive daytime sleepiness. The examination reveals that the patient has large tonsils. He jokingly says that his wife complains that he snores. The respiratory therapist hypothesizes that the patient has which of the following disorders?
Obstructive sleep apnea

31. A patient with sleep apnea is given a noninvasive method of monitoring rest and activity cycles. The patient is required to wear a small watch device on the wrist. What is the name of this method?
Actigraphy is a noninvasive method of monitoring rest and activity cycles. In this method, a small actigraph watch is worn on the wrist to measure gross motor activity. An electromyogram records muscle tone. Polysomnography is also used to measure sleep apnea but through electrodes that record the main stages of sleep and wakefulness. Eye movements are recorded with an electrooculogram.

32. Which assessment question is most appropriate when the respiratory therapist is assessing a patient who is receiving care for suspected obstructive sleep apnea (OSA)?
“Do you smoke?”

33. What does hypopnea mean?
A 30% decrease in airflow with a greater or equal to 4% reduction in SaO2, causing arousals.

34. What is a polysomnogram?
A test performed to determine if a patient has sleep apnea, commonly referred to as a sleep study.

35. What is the Respiratory Disturbance Index (RDI) in sleep apnea?
The number of obstructive apneas, hypopneas, and central apneas per hour, used to diagnose sleep apnea. It is considered abnormal if greater than 5 per hour.

36. What is another name for the Respiratory Disturbance Index (RDI)?
Apnea-Hypopnea Index (AHI)

37. What is the most common type of sleep apnea?
Obstructive Sleep Apnea (OSA)

38. Which type of sleep apnea involves respiratory effort but little or no airflow due to upper airway obstruction?
Obstructive Sleep Apnea (OSA)

39. What are some causes of Obstructive Sleep Apnea (OSA)?
Obesity, tonsil or adenoid hypertrophy, a small or recessed chin, and sometimes nasal abnormalities.

40. What is the medical term for a small chin?
Micrognathia

41. What is the medical term for a recessed chin?
Retrognathia

42. What are the signs and symptoms of Obstructive Sleep Apnea (OSA)?
Excessive daytime sleepiness (EDS), lack of restful sleep, memory loss, poor concentration, irritability, fatigue, morning headaches, depression, frequent motor vehicle accidents, arrhythmias, stroke, congestive heart failure (CHF), snoring, choking, gasping, nocturnal reflux, systemic hypertension, hypoxemia, hypercapnia, polycythemia, pulmonary hypertension, and cor pulmonale.

43. OSA is associated with what issues in children?
Poor school performance, developmental delays, aggression, withdrawal, ADHD, and hyperinsulinemia.

44. What is the leading cause of pediatric sleep apnea?
Enlargement of the tonsils.

45. What does a polysomnogram measure?
Bodily functions during sleep, including EEG, EMG (muscle tone), electro-oculogram (EOG), EKG, airflow at the nose and mouth, chest wall effort, SpO2, and audio-visual recordings.

46. How is chest wall effort measured during a polysomnogram?
With an impedance monitor.

47. What is the major difference between OSA and hypopnea?
OSA involves the absence of airflow for 10 seconds with desaturation and increased effort (rib cage), while hypopnea involves a 30% decrease in airflow for 10 seconds with slight desaturation and minimal increase in rib cage effort.

48. What is central sleep apnea?
A condition where the brain fails to send proper signals, leading to no airflow due to a lack of respiratory effort, showing no effort in the rib cage, abdomen, or PES.

49. What causes central sleep apnea?
CNS lesions, stroke, or congestive heart failure (CHF).

50. Which type of sleep apnea is least common?
Central sleep apnea, accounting for 10-15% of all sleep disorders.

51. What is mixed apnea?
A combination of both central and obstructive apnea, generally starting with central sleep apnea followed by upper airway obstruction.

52. What is the effort and airflow pattern in mixed apnea?
No airflow and little effort.

53. What are common treatments for sleep apnea?
Losing weight, stopping alcohol, tobacco, and sedative use, sleeping on your side, elevating the head of the bed, maintaining regular sleep hours, using nasal dilators or saline spray, CPAP, tonsillectomy and adenoidectomy, UPPP (uvulopalatopharyngoplasty), tracheostomy, and orthodontic devices to pull the lower jaw forward.

54. What is the compliance therapy benefit for CPAP?
If used for more than 4 hours per night for 70% of nights.

55. What are common CPAP problems?
Mask discomfort, air leaks, and rhinitis or congestion.

56. What are the reimbursement criteria for CPAP?
An AHI greater than or equal to 15/hour, or an AHI between 5-14 with excessive daytime sleepiness, impaired cognition, mood disorders, hypertension, history of heart disease, or stroke.

57. When would NIPPV be used?
For nocturnal hypoventilation or when lower expiratory pressure may improve compliance to therapy.

58. What sleep-related disorder is quite common and may cause significant mortality and morbidity?
Sleep apnea

59. What percentage of women have obstructive sleep apnea?
4%

60. What percentage of men have obstructive sleep apnea?
9%

61. Sleep apnea is about as common as which condition?
Asthma

62. What does obstructive sleep apnea (OSA) largely contribute to?
Lost productivity at work and vehicular accidents

63. Which sleep apnea occurs when the respiratory centers of the medulla fail to send signals to the respiratory muscles?
Central sleep apnea (CSA)

64. During central sleep apnea, what stops along with airflow through the nose and mouth?
Inspiratory efforts

65. What conditions are associated with central sleep apnea?
Hypothyroidism, brain stem neoplasm or infarction, congestive heart failure (CHF)

66. What is a combination of obstructive and central sleep apneas called?
Mixed sleep apnea

67. What conditions cause hypoxemia and hypercapnia during sleep?
Sleep apnea

68. What are the effects of hypoxemia and hypercapnia on sleep?
They cause the patient to awaken to breathe, resulting in fragmented and restless sleep, and producing daytime sleepiness.

69. How is sleep apnea diagnosed?
Through bloodwork, chest X-ray, and patient history, including input from the patient’s bed partner.

70. When are snoring, sleep disturbances, and daytime sleepiness typically noted?
During the patient’s history.

71. What type of sleep apnea is confirmed with a polysomnogram?
Obstructive sleep apnea (OSA).

72. The diagnosis of OSA is based on which index?
Apnea-Hypopnea Index (AHI)

73. What does the Apnea-Hypopnea Index (AHI) measure?
The average number of hypopneas and apneas per hour of sleep.

74. What are the AHI severity levels?
Normal: <5 episodes per hour, Mild: 5-15 episodes per hour, Moderate: 15-30 episodes per hour, and Severe: >30 episodes per hour.

75. What index measures how long a person’s SpO2 is below 90% during sleep?
Oxygen Desaturation Index

76. What role do cardiac arrhythmias, tachycardia, and bradycardia play in diagnosing sleep apnea?
They are considered during the diagnosis process.

77. What is normal and not normal in obstructive sleep apnea (OSA)?
The diaphragm and intercostal muscles exhibit normal respiratory effort; the airway collapses, blocking airflow to the lungs.

78. How does a person usually figure out they may have sleep apnea?
Their partner complains about their snoring.

79. How long does a person stop breathing with sleep apnea?
20-60 seconds. The person usually awakens to breathe, often gasping or snorting.

80. How often can awakenings due to sleep apnea interrupt the normal sleep cycle?
Up to 20-30 times per hour.

81. What is a person’s chief complaint when they have sleep apnea?
Feeling tired all the time and being sleepy during the day.

82. How is a person diagnosed with sleep apnea?
In a sleep disorders clinic with a sleep study, or you may notice signs of apnea during hospitalization.

83. What are some nursing interventions and teaching points for sleep apnea?
Weight reduction, stopping smoking, sleeping on the side to keep the airway open, avoiding alcohol before bed, and avoiding or decreasing sleep medications if possible.

84. What are some medical therapy options for sleep apnea?
CPAP (continuous positive airway pressure), BiPAP (uses lower pressure during expiration than CPAP), and surgery for severe cases.

85. What are some common complaints about apnea machines?
Nasal congestion, air leaks, pressure marks on the face, pressure intolerance, discomfort, claustrophobia, and getting tangled in tubing, leading to non-compliance.

86. What are some patient teaching points for using apnea machines?
How to apply and wear the mask, when to use the equipment, cleaning the mask and hoses daily, resupplying masks and hoses every 3-6 months, and never stopping use without reevaluation.

87. What does apnea airway surgery do for the patient?
It widens the breathing passage.

88. What are some nursing interventions for the patient post-op?
Monitoring for bleeding, aspiration, edema (narrowing of the airway), and watching for heavy bleeding when scabs form and fall off.

89. What are two types of surgery for severe sleep apnea?
Maxillomandibular advancement and genioglossus advancement surgery.

90. What is central sleep apnea characterized by?
It is caused by brain lesions, is rare, and often causes Cheyne-Stokes respirations (rapid breathing followed by apnea).

91. What is the usual treatment for central sleep apnea?
CPAP is the usual treatment, but CNS lesions may require a diaphragmatic pacemaker or mechanical ventilation.

92. What should be avoided in central sleep apnea?
Sedative and hypnotic drugs.

93. What should be done if someone with apnea is admitted to the hospital?
Have the patient or family bring the CPAP/BiPAP, as the patient’s own machine is best due to the fit of the mask, pre-programmed settings, and cost.

94. Which type of sleep apnea is characterized by both obstructive and central components?
Mixed sleep apnea

95. What percentage of adults are estimated to have sleep apnea but remain undiagnosed?
Approximately 80% of moderate and severe cases remain undiagnosed.

96. What is a common symptom of sleep apnea that can occur during nighttime sleep?
Loud snoring, choking, or gasping for air.

97. How can untreated sleep apnea affect cardiovascular health?
It can lead to high blood pressure, heart disease, and an increased risk of stroke.

98. What lifestyle modification can help reduce the severity of sleep apnea?
Weight loss, as it can decrease the amount of fatty tissue in the throat.

99. What is the role of a mandibular advancement device in treating sleep apnea?
It helps keep the airway open by moving the lower jaw forward.

100. How does positional therapy work in managing sleep apnea?
It involves sleeping in a position (usually on the side) that helps prevent airway obstruction.

Final Thoughts

Effective management of sleep apnea involves a combination of lifestyle changes, medical treatments, and in some cases, surgical interventions.

Early diagnosis and appropriate treatment can significantly improve sleep quality and overall health, reducing the risk of associated complications.

By raising awareness and understanding of sleep apnea, individuals can take proactive steps to address this condition and enhance their quality of life.