Tuesday, November 6, 2007

This presentation is part of : Innovative Clinical Strategies
Tools for Success: Obstructive Sleep Apnea (OSA): Sleep Patterns Impact on Acute Illness Recovery
Angela P. Halpin, RN, MN, CNS1, Mary K. Hewett, RN, BSN, MS1, and Derrick Makoto Hong, MD2. (1) Nursing Medical Unit Pulmonary, Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA, (2) Hospitalist at Hoag Memorial Hospital Presbyterian, Pacific Hospitalists Association, Newport Beach, CA, USA
Learning Objective #1: State two significant evidence based criteria for screening for obstructive sleep apnea (OSA)
Learning Objective #2: Identify two strategies to assist patients in understanding the OSA impact on oxygenation in their health outcomes

Purpose:  Study aim is to evaluate associations, significance in assessment questions for identification of OSA. Literature sheds light on sleep patterns as impacting patients' risk at all ages (NIH 2004; Cancer Institute 2006). The physiological systems along with responses related to sleep patterns affect cardiovascular, pulmonary, and neurological conditions when oxygenation uptake is delayed during sleep pattern interruptions (Kushida ASA 2005). In critical care units it is evident that acuity and environment plays a role in sleep deprivation. Honkus (2003) reports that sleep deprivation induce a catabolic state and negatively affect the immune system. The cumulative affect on oxygenation and perfusion need to be corrected in order to promote optimal healing.
Description:  The addition of a sleep pattern screen to the admission assessment is a method to provide consistency in identifying patients with known challenges in sleep. Sleep patterns are presented as part of the functional listings (Kozier, B., Erb, G., Blais, K. 1997). Patient history questions are modified to include the following evidence-based criteria:  snoring, day time sleepiness, pause in breathing during sleep, difficulty falling asleep, and difficulty staying asleep-insomnia (ASA 2005).  If any of these are positively identified; a sleep assessment and apnea oximetry study screen is completed.
Conceptual Model 
Patterns of Sleep Assessed  positive,  then complete Sleep Oximetry Study, then interventions/outcomes

Evaluation/Outcome:   Modifications and updates to the admission assessment have improved findings of patients with OSA. Patients fail to see the correlation of maximum oxygenation in promoting healing.  Education is required. Alonso-Fernandez, (2005) concluded that patients with an obstructive sleep apnea have a higher frequency of arrhythmias.  Critical Care units per Lee and Ward (2005) recognize sleep components essential to the patient history. Literature provides reliable measurable screens for nursing to weed out issues that impact patient care healing in acute health episodes. (Carpentino, 2000).