Update on Research and Practices in Major Sleep Disorders: Part I. Obstructive Sleep Apnea Syndrome

By Chaiard, Jindarat; Weaver, Terri E. | Journal of Nursing Scholarship, September 2019 | Go to article overview

Update on Research and Practices in Major Sleep Disorders: Part I. Obstructive Sleep Apnea Syndrome


Chaiard, Jindarat, Weaver, Terri E., Journal of Nursing Scholarship


Sleep disorders have increasingly been highlighted as a public concern. A common problem, sleep disorders affect 70 million in the United States (Institute of Medicine, Committee on Sleep Medicine & Research, 2006) and 45 million in Europe (Olesen, Gustavsson, Svensson, Wittchen, & Jonsson, 2012). Consequences of sleep disruption associated with sleep disorders include short-term sequelae such as stress, somatic problems, and psychosocial issues, including anxiety, depression, memory problems, cognitive processing issues, and risk-taking behavior, as well as long-term effects of cardiovascular disease, hypertension, diabetes, cancer, and low quality of life (Medic, Wille, & Hemels, 2017). Indeed, 30% to 70% of those with obstructive sleep apnea have comorbid conditions (Frost & Sullivan, 2016). The impact on performance, especially related to driving, leads to difficulties with work and increased accidents (Inoue & Komada, 2014; Swanson et al., 2011). Workers with OSA have a two-fold increased risk for having an accident at work (Garbarino, Guglielmi, Sanna, Mancardi, & Magnavita, 2016). The economic burden of untreated OSA is enormous, having a cost similar in magnitude to the cost of diabetes, $132 billion (2002 data), with an estimated $15.9 billion for the 800,000 crashes attributed to OSA (AlGhanim, Comondore, Fleetham, Marra, & Ayas, 2008; Sassani et al., 2004). The unrecoverable cost of those crashes was 1,400 lives (AlGhanium et al., 2008; Sassani et al., 2004). From the perspective of the healthcare system, for each quality adjusted life year (QALY), $3,354 in treatment expense and $11.1 billion in collision costs would be saved with successful CPAP therapy (Sassani et al., 2004). Gains from decreased losses in work productivity, insurance, and property damage would be $314 per QALY and save 980 lives (Sassani et al., 2004).

Given the health and economic burden of sleep disorders, having an understanding of the major conditions and the latest research and practice parameters would be essential to the practice of nursing. Thus, the aim of this two-article narrative review was to provide background information as well as an update on the latest in research and practice on major sleep disorders. Part I of this two-part series addresses the classification, prevalence, diagnosis, and treatment of obstructive sleep apnea. Part II (in a following issue of Journal or Nursing Scholarship) will cover insomnia, restless leg syndrome (Willis-Ekbom disease), and narcolepsy. Medical databases, such as PubMed, were utilized to identify relevant English language original and systematic review articles predominantly from peer-reviewed journals from 2012 to 2018. However, findings from classic articles prior to 2012 were also included.

Classification, Prevalence, and Diagnosis of Obstructive Sleep Apnea

The metric used to categorize OSA severity is the apnea-hypopnea index (AHI), defined as the number of apnea and hypopnea events per hour of sleep (Usmani, Chai-Coetzer, Antic, & McEvoy, 2013). An AHI of 5 to 14 is considered mild, 15 to 30 moderate, and greater than 30 severe. The AHI is determined by either inlaboratory polysomnography (PSG) or home sleep testing (HST) (Chai-Coetzer, Antic, & McEvoy, 2013), categorized as Level 1 to Level 4 devices based on the number of parameters recorded. Typically these devices measure air flow, respiratory effort, and oximetry and do not record electroencephalography, electrooculography, and electromyography, needed to stage sleep and assessed in inlaboratory polysomnography and Level 3 or 4 devices (Chai-Coetzer et al., 2013; Senaratna et al., 2017).

In a large-scale survey of adults in the United States, the prevalence of moderate to severe OSA in those 30 to 70 years of age was 10% to 17% among men and 3% to 9% among women (Peppard et al., 2013). In a recent systematic review of 24 prevalence studies, 14 conducted in Europe and 5 in North America, the occurrence of OSA ranged from 9% to 38% based on AHI (Senaratna et al. …

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