Primary care collaborative practice: selected topics and concepts

Obstructive Sleep Apnea
Overview
Obstructive sleep apnea (OSA) happens to be the most common of all the other kinds of sleep apnea – with the other types of OSA being mixed sleep apnea and central sleep apnea. Garvey, Pengo, Drakatos and Kent (2015) point out that as a matter of fact, there is evidence to suggest that it is the most common respiratory disorder. This, in the words of the authors, is more so the case given “recent data from the United States and Europe suggesting that between 14% and 49% of middle-aged men have clinically significant OSA” (Garvey, Pengo, Drakatos and Kent, 2015, p. 274).
Breathing Cessations and Severity Assessment
In basic terms, OSA involves periodic breathing cessations during sleep – with the occurrence (and the number) of the said cessations varying significantly. Most cases of OSA go unrecognized, effectively meaning that a very small percentage of those suffering from the same seek medical attention. According to Garvey, Pengo, Drakatos and Kent (2015), the severity of sleep apnea “is usually assessed by the apnea-hypopnoea index (AHI) which is the number of complete (apneas) or incomplete (hypopneas) obstructive events per hour of sleep” (275).
Symptoms
OSA comes about when, during sleep, an individual’s airways are either partially or completely blocked. In this case, the relaxation of the muscles in the throat triggers the ‘sagging’ or falling back of either the throat’s fatty tissues and/or tongue into an individual’s airways – effectively obstructing airflow. When this occurs, the brain is signaled to awaken partially, with the result being snorting, choking, as well as gasping as the body attempts to restore airflow. This can occur numerous times during a single night.
There are several symptoms associated with OSA. Some of the more common symptoms identified by Silber, Krahn, and Morgenthaler (2016) include, but they are not limited to, nighttime sweating, loud snoring, morning headaches, high blood pressure, sore throat and a dry mouth in the morning, chocking and gasping after waking up abruptly, decreased libido, as well as excessive sleepiness and fatigue during the day.
Diagnosis
There are several diagnostic tests that could be ordered in primary care. Evaluations are founded on not only the signs and symptoms presented by the patient, but also on various examinations and tests. Physical examination could be inclusive of an observation of the patient’s throat, nose, as well as mouth for any abnormality. Routinely, a blood pressure reading is also taken. Tests could be inclusive of polysomnography which is “the recording of multiple physiologic parameters during sleep” (Silber, Krahn, and Morgenthaler, 2016, p. 34).
Treatment
The relevance of seeking treatment for OSA cannot be overstated. This is more so the case given that as Garvey, Pengo, Drakatos, and Kent (2015), point out, in addition to being at a higher risk of motor vehicle accidents, untreated patients are also “more likely to die of cardiovascular disease” (278). The treatment plan could incorporate CPAP machine and nasal sprays (in instances involving nasal congestion). There is also need for the individual suffering from OSA to reduce weight if they happen to be obese. This is more so the case given that “weight loss improves symptoms and morbidity in all patients with obesity and bariatric surgery is an option in severe obesity” (Garvey, Pengo, Drakatos and Kent, 2015, p. 274). Other lifestyle changes that could improve the treatment outcomes include quitting smoking, moderate drinking, and regular exercises.
References
Garvey, J.F., Pengo, M.F., Drakatos, P. & Kent, B.D. (2015). Epidemiological Aspects of Obstructive Sleep Apnea. Journal of Thoracic Disease, 7(5), 920-929.
Silber, M.H., Krahn, L.E. & Morgenthaler, T.I. (2016). Sleep Medicine in Clinical Practice (2nd ed.). New York, NY: CRC Press.