Exploring the Impact of Sleep Apnoea on Daily Life and Occupational Engagement
O'Donoghue, Niamh, McKay, Elizabeth A., British Journal of Occupational Therapy
Occupational therapy is founded on the health-promoting benefits of occupational engagement. Occupations are non-repeatable, personally constructed events (Pierce 2001). The centrality of occupational engagement to the human experience was argued by Wilcock (2007), who asserted that humans have a biological need to engage in occupations, which impacts directly on their health, wellbeing and survival.
Meyer (1922/1977), one of the founding fathers of occupational therapy, recognised sleep as necessary in ensuring that the human organism was balanced and healthy Despite this, little is written in occupational therapy regarding sleep or sleep disorders. In a review of the occupational therapy literature, Green (2008) reported that lack of sleep, insomnia, resulted in disruption to all aspects of daily activities, including work performance, driving and social functioning, and had an overall negative impact on quality of life. Notwithstanding sleep functioning being fundamental to positive occupational engagement, it has been largely ignored in the occupational therapy literature. It is hypothesised that this is due to the occupational therapy value system, with work, leisure and self-care emphasised and little consideration given to sleep or rest (Nurit and Michal 2003). However, the importance of sleep to occupational engagement is receiving increased attention, as the revised version of The Occupational Therapy Practice Framework: Domain and Process has recategorised 'rest and sleep' from being an activity of daily living to being an area of occupation, in recognition of the vital role it plays in supporting healthy engagement in all areas of occupation (Hofmann 2008).
Considering the importance of sleep to occupational engagement, this study investigates how obstructive sleep apnoea (OSA), a sleep disorder, impacts on daily life and occupational engagement. Apnoea is a Greek word meaning 'without breath' (American Sleep Apnea Association 2008). As a person with OSA falls asleep, the upper airway collapses preventing oxygen from reaching the lungs. The brain then automatically wakens the body, usually with a loud snort or snore. A person with OSA can awaken hundreds of times each night without realising (Eberhardie 2006). As a result, the individual is not rested and remains tired throughout the day.
In terms of treatment, the gold standard for treating OSA is the continuous positive airway pressure (CPAP) machine. It is a breathing device worn over the mouth or the nose, or both, which uses mild air pressure to keep the airway open during sleep (McMahon et al 2003). OSA is twice as common in men as women, and risk factors include obesity and genetic predisposition (Young et al 1993, 2005). Mitchell (2008) estimated that 10,000 people in Ireland were affected. The actual number is probably higher, with 4% of men and 2% of women affected worldwide, suggesting over 60,000 people affected in Ireland. Considering the rise in obesity levels, this figure may increase further (Whelton et al 2007).
Between February 2010 and April 2011, database searches were carried out using AMED, Cinahl, InformaHealthCare, Medline, Nursing and Allied Health and PsycINFO, with the following search terms: occupation, occupational therapy, occupational engagement, sleep, sleep disorders, sleep apnoea, OSA, daily functioning, quality of life, life satisfaction. The search focused on literature published within the last 15 years; however, some flexibility ensured that pertinent research was not omitted.
Impact of OSA on health and wellbeing
Substantial quantitative research has been published regarding OSA's impact on health and wellbeing (Young et al 1993, 2005, Finn et al 1998, Engleman et al 2000, Peppard et al 2000, Beebe and Gozal 2002, Ohayon 2003). The Wisconsin Sleep Cohort (WSC) study is probably the most influential. Since 1989, this longitudinal study has followed a random sample of 1,522 state employees. …