The primary care provider examines S.R. and documents a long soft palate, recessed mandible, and medium-sized tonsils

Question

S.R. undergoes an overnight screening oximetry study, which shows 143 episodes
of desaturation ranging from 68% to 76% with episodes of apnea. He is tentatively diagnosed with
obstructive sleep apnea (OSA), and a full sleep study is ordered.

S.R. and his wife ask about a full sleep study. How would you explain a polysomnogram to them?

S.R. and his wife ask why they need to be concerned about OSA. You tell them that treating
OSA is necessary to prevent which common complications? Select all that apply.
a. Stroke
b. Early onset of chronic obstructive pulmonary disease (COPD)
c. Hypotension
d. Right-sided heart failure

The provider asks you to teach S.R. about lifestyle changes that he could make immediately
to help with his situation. Describe four priority topics you would address with S.R.

Answer 1

A polysomnogram will show the depth and type of sleep, as well as how well you are breathing during
sleep. The test will take place in a sleep laboratory; a sleep technician will monitor you throughout the
night. Your chest and abdominal movement, oral airflow, nasal airflow, Spo2, ocular movement, and
heart rate and rhythm will be monitored. All of this monitoring will require that several wires be taped
to your head and face. Although the testing will not be painful, you might find it difficult to sleep with
all of the equipment attached to you and in the unfamiliar environment of the laboratory.

Answers: a, d, e
Complications that can result from untreated sleep apnea include cardiovascular changes, such
as hypertension, right-sided heart failure from pulmonary hypertension caused by chronic nocturnal
hypoxemia, and cardiac dysrhythmias, as well as an increased risk of stroke and insulin resistance.
Untreated OSA does not lead to hypotension or an early onset of COPD.

• Begin efforts to lose weight. He could immediately begin a walking program and start an
appropriate diet.
• Avoid back sleeping. He can sew a pouch in the back of a nightshirt and put tennis balls in it, so he
is less likely to sleep on his back.
• Elevate the head of bed.
• Initiate smoking cessation efforts. He can enroll in a smoking cessation program or use nicotine
patches, gum, or prescription medications to help him stop smoking.
• Decrease caffeine intake. He can start mixing his coffee with decaffeinated coffee to decrease the
caffeine.