After interviewing S.R., you note the following: S.R. is under considerable stress. He owns his own business. The stress of overseeing his employees, meeting deadlines, and carrying out negotiations has led to poor sleep habits

Question

He sleeps 3 to 4 hours per night. He keeps himself going by drinking 2 quarts of coffee and smoking
three to four packs of cigarettes per day. He has gained 50 pounds over the 2 years, leading to a current weight
of 250 pounds. He complains of difficulty staying awake, wakes up with headaches on most mornings, and has
midmorning somnolence. He states that he is depressed and irritable most of the time and reports difficulty
concentrating and learning new things. He has been involved in three auto accidents in the past year.
S.R.'s vital signs are 164/90, 92, 18, and Spo2 90% on room air. His examination findings are normal,
except for a few bruises over the right side of the rib cage. You inquire about the bruises, and S.R. reports
that his wife jabs him with her elbow several times every night. In her own defense, the wife states, "Well,
he stops breathing and I get worried, so I jab him to make him start breathing again. If I don't jab him, I
find myself listening for his next breath and I can't go to sleep." You suspect sleep apnea.

Identify two of the main types of apnea, and explain the pathology of each.

Based on your findings, which type of sleep apnea do you believe S.R. has?

Identify at least five signs or symptoms of this type of sleep apnea, and put a star next to those symptoms that S.R. is experiencing.

How does the provider use diagnostic testing to diagnose sleep apnea?

Answer 1

Central sleep apnea: This type of apnea is less common and occurs when the brain fails to send the
appropriate signals to the inspiratory muscles to initiate respiration. There is no respiratory effort.
It may be seen with central nervous system (CNS) lesions, such as in stroke or brain stem trauma.
Cheyne-Stokes respirations are common with this syndrome.
Obstructive sleep apnea (OSA): This type of apnea is more common. It is caused by airflow obstruction
during sleep because of narrowed air passages from relaxed muscle tone or the tongue and
the soft palate falling backward and partially or completely obstructing the pharynx. Each
obstruction lasts from 10 to 90 seconds. During the apneic period, the patient develops
hypoxemia and hypercapnia, which eventually stimulate respirations. The patient may arouse
with a startle, snort, and/or gasp. These frequent awakenings interrupt the normal sleep cycle.
The actual cause of OSA is unknown, but sleep apnea is a potentially life-threatening condition.

S.R.'s history suggests a diagnosis of OSA.

• Cessation of respiration during sleep, usually followed by gasping for breath*
• Excessive daytime somnolence or fatigue*
• Reports of "not feeling rested" in the morning*
• Memory loss*
• Poor judgment
• Lethargy
• High BP*
• Confusion
• Headache*
• Weight gain*

• Thorough physical examination, focusing on an examination of the upper airway, is performed to
detect any assessment abnormalities.
• An overnight screening oximetry test is done to determine whether the patient desaturates during sleep.
• Polysomnography is the gold standard for diagnosis, and it is often done if desaturation is
detected during overnight screening oximetry. It is usually conducted in a sleep laboratory. A
portable sleep study in the home may be done in certain circumstances.