Nursing assessment of obstructive sleep apnea in hospitalised adults: A review of risk factors and screening tools
Alison Sheldon
School of Nursing & Midwifery, Flinders University, Adelaide SA, Australia
Ingrid Belan
School of Nursing & Midwifery,Flinders University, Adelaide SA, Australia
Jane Neill
School of Nursing & Midwifery, Flinders University, Adelaide SA, Australia
Sharn Rowland
Clinical Practice Consultant, The Adelaide Institute of Sleep Health, Daw Park SA, Australia
PP: 19 - 33
Abstract
Obstructive sleep apnea (OSA) affects approximately 2-4% of the general population and may be more prevalent in obese adults. However, sleep apnea remains consistently under-diagnosed in the general population as well as in hospital wards. Nurse awareness of OSA during routine monitoring could allow specific observations of hospitalised adults to identify those at high risk and ensure appropriate referral. This integrative literature review analysed major risk factors for OSA and identified screening tools that nurses could utilise in hospital wards. The most important risk factors relevant to nursing practice in hospital settings were obesity, hypertension and sleep position. The most suitable screening tool was the Berlin Questionnaire, while there was some evidence to support measuring waist circumference. A nursing assessment flow chart was developed based on the literature reviewed. This paper highlights a role for nurses in recognising patients at risk of OSA and minimising complications in hospitalised adults.
Keywords
Sleep apnea, screening, assessment, risk factors, nursing, hospital
References
Australian Nursing & Midwifery Council (ANMC), National competency standards for the registered nurse (2006) 4th edn, accessed at http://www.anmc.org.au/docs/Competency_standards_RN.pdf on 25 January 2009.
Bailes S, Baltzan M, Alapin I, Fichten CS and Libman E (2005) Diagnostic indicators of sleep apnea in older women and men: a prospective study, Journal of Psychosomatic Research 59(6): 365-373.
Chung F, Ward B ,Ho J, Yuan H, Kayumov L and Shapiro C (2007) Preoperative identification of sleep apnea risk in elective surgical patients, using the Berlin Questionnaire, Journal of Clinical Anesthesia 19(2): 130-4.
Davidson TM and Patel MR (2008) Waist circumference and sleep disordered breathing, Laryngoscope 118(2): 339-47.
Dixon JB, Schachter LM and O'Brien PE (2003) Predicting sleep apnea and excessive day sleepiness in the severely obese: indicators for polysomnogram, Chest: The Cardiopulmonary and Critical Care Journal 123(4): 1134-1141.
Drager LF, Bortolotto LA, Figueiredo AC, Silva BC, Krieger EM and Lorenzi-Filho G (2007) Obstructive sleep apnea, hypertension, and their interaction on arterial stiffness and heart remodeling, Chest: The Cardiopulmonary and Critical Care Journal 131(5): 1379-1386.
Farney RJ, Lugo A, Jensen RL, Walker JM, Cloward TV (2004) Simultaneous use of antidepressant and antihypertensive medications increases likelihood of diagnosis of obstructive sleep apnea syndrome, Chest: The Cardiopulmonary and Critical Care Journal 125(4): 1279-85.
Goncalves SC, Martinez D, Gus M, de Abreu-Silva EO, Bertoluci C, Dutra I, Branchi T, Moreira LB, Fuchs SC, de Oliveira AC and Fuchs FD (2007) Obstructive sleep apnea and resistant hypertension: a case-control study, Chest: The Cardiopulmonary and Critical Care Journal 132(6): 1858-62.
Goncalves MA, Paiva T, Ramos E and Guilleminault C (2004) Obstructive sleep apnea syndrome, sleepiness, and quality of life, Chest: The Cardiopulmonary and Critical Care Journal 125(6): 2091-2096.
Hallowell PT, Stelloato TA, Schuster M, Graf K, Robinson A, Crouse C and Jasper JJ (2007) Potentially life threatening sleep apnea is unrecognised without aggressive evaluation, The American Journal of Surgery 193: 364-367.
Hayashi M, Fujimoto K, Urushibata K, Uchikawa S, Imamura H and Kubo,K, (2003) Nocturnal oxygen desaturation correlates with the severity of coronary atherosclerosis in coronary artery disease, Chest: The Cardiopulmonary and Critical Care Journal 124(3): 936-41.
Health Care Practice Research and Development Unit (HCPRDU) (2003), Evaluation Tool for Quantitative Studies, University of Salford, Salford, accessed at http://www.fhsc.salford.ac.uk/hcprdu/tools/quantitative.htm on 30 April 2008.
Hiestand DM, Britz P, Goldman M and Phillips, B (2006) Prevalence of symptoms and risk of sleep apnea in the US population: Results from the national sleep foundation sleep in America 2005 poll, Chest: The Cardiopulmonary and Critical Care Journal 130(3): 780-6.
Hwang D, Shakir N, Limann B, Sison C, Kalra S, Shulman L, Souza Ade C and Greenberg H (2008) Association of sleep-disordered breathing with postoperative complications, Chest: The Cardiopulmonary and Critical Care Journal 133(5): 1128-34.
Indications for Polysomnography Taskforce American Sleep Disorder Association (ASDA) Standards of Practice Committee (1999) Practice parameters for the indications for polysomnogrphy and related procedures, Sleep 20(6): 406-422.
Ingman T, Nieminen T and Hurmerinta K 2004 Cephalometric comparison of pharyngeal changes in subjects with upper airway resistance syndrome or obstructive sleep apnea in upright and supine positions, European Journal of Orthodontics 26: 321-326.
Larsson, L-G, Lindberg, A, Franklin, KA and Lundback, B (2003) Gender differences in symptoms related to sleep apnea in a general population and in relation to referral to sleep clinic Chest: The Cardiopulmonary and Critical Care Journal 124(1): 204-211.
Lavie L, Vishnevsky A and Lavie P (2007) Oxidative stress and systemic inflammation in patients with sleep apnea: Role of obesity, Sleep and Biological Rhythms 5: 100-110.
Lee CY, Low LPL and Twinn S (2008) Older patients' experiences of sleep in the hospital: Disruptions and Remedies, The Open Sleep Journal 1: 29-33.
Lee CY, Low LPL and Twinn S (2007) Older men's experiences of sleep in the hospital, Journal of Clinical Nursing 16: 336-343.
Lee CY, Low LPL and Twinn S (2005) Understanding the sleep needs of older hospitalized patients: A review of the literature, Contemporary Nurse 20: 212-220.
Magalang UJ, Dmochowski J Veeramachaneni S, Drew A, Mador MJ, El-Solh A and Grant BJB (2003) Prediction of the apnea-hypopnea index from overnight pulse oximetry, Chest: The Cardiopulmonary and Critical Care Journal 124: 1694-1701.
Martinez-Rivera C, Abad J, Fiz JA, Rios J and Morera J (2008) Usefulness of truncal obesity indices as predictive factors for obstructive sleep apnea syndrome, Obesity 16(1): 113-8.
Montoya FS, Bedialauneta JRI, Larracoechea UA, Ibargüen AM, Rey ASD and Fernandez JMS (2007) The predictive value of clinical and epidemiological parameters in the identification of patients with obstructive sleep apnoea (OSA): a clinical prediction algorithm in the evaluation of OSA, European Arch Otorhinolaryngol 264(6) 637-643.
National Health and Medical Research Council (NHMRC) (2005), NHMRC additional levels of evidence and grades for recommendations for developers of guidelines: pilot program 2005-2000 accessed at http://www.nhmrc.gov.au/guidelines/_files/levels_grades05.pdf on 9 January 2009.
Netzer NC, Hoegel JJ, Loube D, Netzer CM, Hay B, Alvarez-Sala R and Strohl CM (2003) Prevalence of symptoms and risk of sleep apnea in primary care, Chest: The Cardiopulmonary and Critical Care Journal 124(4): 1406-1414.
Oeverland B, Skatvedt O, Kvaerner KJ, Akre H, (2002) Pulse oximetry: Sufficient to diagnose severe sleep apnea, Sleep Medicine 3(2): 133-8.
Ogretmenoglu O, Suslu AE, Yucel OT, Onerci TM and Sahin A (2005) Body fat composition: A predictive factor for obstructive sleep apnea, The Laryngoscope 115(8): 1493-1498.
Okabayashi K, Kasahara E, Uchiyama H, Yokota K, Togashi Y, Kono C, Yamada Y, Amano H, Yamaguchi T, Kawamoto T, Fujihara H and Ueta Y (2007) Obstructive sleep apnea-hypopnea syndrome patients with overweight and hypertension in a Japanese workplace, Journal of Occupational Health 49(2): 117-24.
Olson EJ, Moore WR, Morgenthaler TI, Gay PC and Staats, B (2003) Obstructive sleep apnea-hypopnea syndrome, Mayo Clinic Proceedings 78(12): 1545-1552
Pang KP and Terris J (2006) Screening for obstructive sleep apnea: an evidence-based analysis, American Journal of Otolaryngology 27(2): 112-118.
Polit DF and Beck CT (2004) Nursing research: Principles and Methods, 7th edn, pp. 101, 692-693, Lippincott Williams & Wilkins, Philadelphia.
Quintana-Gallego E, Carmona-Berna C, Capote F, Sanchez-Armengol A, Botebol-Benhamou G, Polo-Padillo J and Castillo-Gomez J (2004) Gender difference in obstructive sleep apnea syndrome: a clinical study of 1166 patients, Respiratory Medicine 98(10): 984-989.
Richard W, Kox D, den Herder C, Laman M, van Tinteren H and de Vries N (2006) The role of sleep position in obstructive sleep apnea syndrome, European Archives of Oto-Rhino-Laryngology 263(10): 946-50.
Scales BA (2003) Screening high-risk patients for the ambulatory setting, Journal of Peri-Anesthesia Nursing 18(5): 307-316.
Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, O'Connor GT, Boland LL, Schwartz JE, and Samet JM for the Sleep (2001) Sleep-disordered breathing and cardiovascular disease cross-sectional results of the Sleep Heart Health Study, American Journal of Respiratory and Critical Care Medicine 163: 19-25.
Sharma SK, Vasudev C, Sinha S, Banga A, Pandey RM and Handa KK (2006) Validation of the modified Berlin questionnaire to identify patients at risk for the obstructive sleep apnoea syndrome, Indian Journal of Medical Research 124(3): 281-90.
Walker RP, Durazo-Arvizu R, Wachter B and Gopalsami, C (2001) Preoperative differences between male and female patients with sleep apnea, The Laryngoscope 111(9): 1501-1505.
Weaver EM, Woodson BT and Steward DL (2005) Polysomnography indexes are discordant with quality of life, symptoms, and reaction times in sleep apnea patients, Otolaryngology-Head and Neck Surgery 132(2): 255-62.
World Health Organization WHO (2006) Obesity and Overweight. Fact Sheet No. 311, September, accessed at www.who.int.mediacentre/factsheets/fs311/en/print.html on 2 April 2009.
Wright, KP Jr, Hull, JT, and Czeisler, CA (2002) Relationship between alertness, performance, and body temperature in humans, American Journal of Physiology: Regulatory, Integrative and Comparative Physiology 238: R1370-R1377.
Young T, Skatrud J and Peppard PE (2004) Risk factors for obstructive sleep apnea in adults, Journal of American Medical Association 291(16) 2013-2016.
Young T, Evans L and Finn L (1997) Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle aged men and women, Sleep 20: 705-706.
Zafar S, Ayappa I, Norman R, Krieger A, Walsleben J and Rapoport D (2005) Choice of oximeter affects apnea-hypopnea index, Chest: The Cardiopulmonary and Critical Care Journal, 127(1): 80-88.

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