Hello,
I chose to do my journal club post on obstructive sleep apnea its relationship to obesity. I work on a respiratory step-down unit, and I tend to see many old and young people who have been diagnosed as morbid obese with several respiratory issues. It is something that can be uncomfortable to discuss but certainly needs to be addressed. There have been a number or rapid calls on my unit due to patients dropping in O2 sats low enough to require intubation. As a med-surg unit, we focus on total care not just respiratory issues, so I thought that learning more about the direct correlation would be beneficial.
Resources
Rouatbi, S., Ghannouchi, I., Kammoun, R., & Ben Saad, H. (2020). The Ventilatory and Diffusion Dysfunctions in Obese Patients with and without Obstructive Sleep Apnea-Hypopnea Syndrome. Journal of Obesity, 1–6. https://doi-org.ezproxy.fhsu.edu/10.1155/2020/8075482
Obesity places patients at higher risk for Obstructive Sleep Apnea. Being obese is associated with decreased amount of sleep compared to non-obese patients (Jehan, Zizi, Pandi-Peruman, Wall, Auguste, Myers, Jean-Louis, & McFarlane, 2017). Obesity is associated with poor sleep quantity and quality, thus weight reduction can ameliorate sleep problems (Jehan, Zizi, Pandi-Peruman, Wall, Auguste, Myers, Jean-Louis, & McFarlane, 2017). Obesity is a preventable health problem. Weight loss is recommended in obese patients with Obstructive Sleep Apnea Syndrome (OSAS) as it improves overall health and reduces the severity of OSAS. Losing weight is difficult. Weight loss and weight maintenance therapies should include reduced calorie diet, increased physical activity, and behavioral therapy. Since you stated that many of your patients are in denial about their condition, I would advise that you first assess their ability to listen or be educated about weight loss. It can be a very sensitive topic. Hopefully, you have a good rapport with these patients so that they can feel comfortable talking to you about the challenges of weight loss and not feel so judged. You are in a tough position. Good luck!
Jehan, S., Zizi, F., Pandi-Perumal, S. R., Wall, S., Auguste, E., Myers, A. K., Jean-Louis, G., & McFarlane, S. I. (2017). Obstructive sleep apnea and obesity: implications for public health. Sleep Medicine Disorder, 1(4), 1-15.
I think that most of us would quickly link OSA to obesity, but I have met several people who are not obese and have OSA, which is why I was intrigued by this topic. Like you stated, weight loss/ obesity can be sensitive topics, and education about weight loss/control is essential in preventing further health issues, like OSA. Also I
agree that building a good rapport with these patient is the foundation for this discussion and will ensure its success.
This is a very interesting and important subject. I work in surgical recovery and this can be a big issue for us in the PACU. I have recently cared for a patient who developed negative pressure pulmonary edema related to sedation and his sleep apnea and I have cared for many other patients who have developed complications related to sleep apnea that have put them into critical condition and/or changed the course of their recoveries. Kadam, Markman, & Neumann (2015) discuss some of these complications in their article including increased risk for complications, challenging endotracheal intubations, low oxygen levels, arrhythmias, extended admissions and ICU admissions. These researchers suggest that screening is an important tool prior to undergoing anesthesia and that patients may benefit from 23-hour hospital stays after procedures (Kadam, Markman, & Neumann (2015). Addressing and diagnosing sleep apnea is to the benefit of the patient’s current health but also for the prevention of other issues that can result from sleep apnea.
Kadam, V. R., Markman, P., & Neumann, S. (2015). Risk stratification for obstructive sleep apnoea and optimal post-operative monitoring in an overnight stay ward. Australian Journal of Advanced Nursing, 33(2), 12–19.
I had not even stopped to think about patients in the PACUs. This is all new and interesting information to me as I have not ever worked or been around these settings. I definitely do agree with extensive screening being necessary prior to sedation. Now that you mention it, I have had several patients not return to the floor after procedures due to sedation complications. I do not recall if any of these patients had OSA, but I will keep it in mind now.
When we screen patients at my place of employment for sleep apnea, one of the questions is ‘is the BMI >35?’ So I’ve always assumed there is a relationship. However, my brother was in high school when he was diagnosed with sleep apnea. He wrestled 145# and is 6’3″ tall – not obese by any means. One factor I noticed in the research you collected was all the participants were males. It did not state women were excluded and the study was on 48 obese adults. This made me want to look into the gender differences in obstructive sleep apnea. I found an article entitled, Gender differences in obstructive sleep apnea syndrome: a clinical study of 1166 patients. The results of the research stated “of the 1745 patients with suggestive clinical symptoms of OSA included in the study, 1386 were men and 359 women.”
Quintana-Gallego, E., Carmona-Bernal, C., Capote, F., Sánchez-Armengol, Á., Botebol-Benhamou, G., Polo-Padillo, J., & Castillo-Gómez, J. (2004, April 23). Gender differences in obstructive sleep apnea syndrome: a clinical study of 1166 patients. Retrieved from https://www.sciencedirect.com/science/article/pii/S0954611104001064
Although I work on a respiratory step-down unit, we do not have any particular BMI questions or screening tools for OSA. I too have known several people with OSA that are not obese or even overweight, which is one of the reasons this topic intrigued me. I too wondered why the study had focused on males, but then I did some other research and found out that OSA was more prominent in males. The study you found supports that as well. It would be interesting to see a more gender neutral study with correlations to obesity and OSA.
Unfortunately there are millions of people that are undiagnosed when it comes to sleep apnea and when left untreated can lead to other health issues such as high blood pressure, chronic heart failure, and atrial fibrillation to name a few. This can become troublesome especially if the patient is unaware of having sleep apnea and is going to be undergoing surgery. This is why it is imperative to have a thorough pre-operative assessment. The patient with sleep apnea is typically a male over the age of 40 and overweight but it can occur at any age, sex and weight. A sleep study may be needed if sleep apnea is suspected. This would be at the best interest of all parties involved to avoid complications intra and post-operatively.
References:
Anesthesia Safety Always an Issue with Obstructive Sleep Apnea. Retrieved from https://www.apsf.org/article/anesthesia-safety-always-an-issue-with-obstructive-sleep-apnea/
Sleep Apnea Information for Clinicians. (n.d.). Retrieved from https://www.sleepapnea.org/learn/sleep-apnea-information-clinicians/
Sleep apnea is a serious health issue that is often overlooked. The facility I work at used to do sleep studies once a month. A mobile service would come and set everything up and monitor patients. I thought it was a very unique way to have a sleep study done. I have heard of others being able to a sleep study from the privacy of their own home. I think this would warrant the best results because the patient would be able to relax without the anxiety of being in a hospital or a strange place.
I agree that OSA is often overlooked. I also agree with you in that sleep studies are more efficient when conducted in the comfort of the subject’s home. Patient’s typically complain of how uncomfortable hospital beds are and even report increased anxiety due to being in a hospital setting. There are also details like what kind of pillows, how many pillows, and other comfort factors that are harder to accommodate for in a hospital setting. I had not heard of the mobile service either. Most sleep studies I have known of have been done in hospitals.
Sleep apnea is often closely looked at in relationship to obesity. Physical activity and sedentary lifestyles have a large part in sleep apnea. The study that I found evaluated the relationship between physical activity and sleep apnea. They found not everyone was obese in the study but instead had little to no physical activity and led a sedentary lifestyle that contributed to their sleep apnea.
Igelström, H., Emtner, M., Lindberg, E., & Åsenlöf, P. (2013). Level of Agreement Between Methods for Measuring Moderate to Vigorous Physical Activity and Sedentary Time in People With Obstructive Sleep Apnea and Obesity. Physical Therapy, 93(1), 50–59. doi: 10.2522/ptj.20120123
Obesity is a huge risk factor for obstructive sleep apnea. I read an article from the obesity medicine association that stated about 70% of adults with OSA are obese. Obesity is the only risk factor of OSA that is reversible. sleep apnea is also significant in the pediatric population. Children with obesity have a 46% increased risk of OSA compared to their normal-weight peers.
Obesity and Obstructive Sleep Apnea. (2018, August 2). Retrieved from https://obesitymedicine.org/obesity-and-sleep-apnea/
I have had several adult patients that are not obese or overweight with OSA, so there are other underlying factors. For the most part, the majority of them are obese though. I have not worked with peds, but I would love to one day, and this information will be helpful, especially if I pursue a career in NICU.
I’ve often noticed an association with obese patients and the increased likelihood of them having apnea and needing CPAP at night. I have not really researched the topic very much so this article was interesting to read. The decrease in lung capacity makes sense for obese patients, especially morbidly obese patients. It is always a sensitive subject when educating patients about their comorbidities and the association with their weight and need for healthier lifestyles. However, it is important for them to understand that it’s possible to reverse OSA or other health issues they are having.