1. The first thing that we would ask the patient is about his sleeping habits. How many hours a night are you sleeping? How often do you get up during the night? Do you have any medical conditions or take any medications? By obtaining a complete health history on the patient we will be better equipped to make a nursing diagnosis.
VS and O 2 saturation
Pertinent medical history: lung diseases such as asthma or emphysema, diabetes mellitus, hypothyroidism
Environmental factors: wood-burning stove, animals in the home (especially birds and cats)
Pertinent nasal problems: deviated septum, chronic sinusitis
Allergies: particularly airborne particles such as animal dander, dust mites, cockroach droppings
Medications he is currently taking: opioids, modafinil (Provigil), amphetamines (prescribed and illegal), OTC drugs, and herbals

2. The two main types of sleep apnea are Obstructive Sleep Apnea (OSA) and Central Sleep Apnea (CSA). OSA is the more common type and is usually a result of obesity. Obstructive sleep apnea occurs when the muscles in the back of your throat relax. These muscles support the soft palate, the triangular piece of tissue hanging from the soft palate (uvula), the tonsils, the side walls of the throat and the tongue.
When the muscles relax, your airway narrows or closes as you breathe in, and you can't get an adequate breath in. This may lower the level of oxygen in your blood.
Your brain senses this inability to breathe and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don't remember it. Central sleep apnea or CSA is a less common form of sleep apnea that occurs when your brain fails to transmit signals to your breathing muscles. This means you make no effort to breathe for a short period of time. You may awaken with shortness of breath or have a difficult time getting to sleep or staying asleep. (Staff, 2015)
Central sleep apnea: This type of apnea is less common and occurs when the brain fails to send the appropriate signals to the inspiratory muscles to initiate respiration. There is no respiratory effort.
Obstructive sleep apnea (OSA): This type of apnea is more common and is due to the obstruction and/or collapse of the tongue, uvula, and soft palate, forming a tight blockage that prevents air from entering the lungs. Respiratory effort continues despite lack of airflow—this is an apnea event. The actual cause of OSA is unknown, but sleep apnea is a potentially life-threatening condition. Early recognition and treatment are important because the long-term consequences of sleep apnea include MI, high BP (HTN), and arrhythmias. If it continues over a prolonged period, it can lead to pulmonary HTN and right-sided HF, polycythemia, and CVA. Although the mechanism is unknown, uncontrolled DM has been associated with apnea; conversely, controlling DM has been shown to control OSA.

3. Signs of OSA * Loud snoring, which is usually more prominent in obstructive sleep apnea * * Episodes of breathing cessation during sleep witnessed by another person * * Abrupt awakenings accompanied by shortness of breath, which more likely indicates central sleep apnea * Awakening with a dry mouth or sore throat * Morning headache * * Difficulty staying asleep (insomnia) * * Excessive daytime sleepiness (hypersomnia) * * Attention problems * * Irritability *
• Cessation of respiration during sleep usually followed by gasping for breath*
• Excessive daytime somnolence or fatigue*
• Reports of “not feeling rested” in the morning*
• Memory loss*
• Poor judgment
• Lethargy
• High BP*
• Confusion
• Headache*
• Weight gain* 4. The most common test used to diagnosis OSA is the nocturnal polysomnography or sleep study test, which usually takes place at a medical facility. Doctors may also request a home sleep study. In some cases they may also want a consultation with an ENT or Cardiologist.
• Physical examination of the upper airway is performed.
• Overnight screening oximetry test is done to determine whether the patient desaturates during sleep.
• Polysomnogram is the gold standard for diagnosis, and it is often done if desaturation is detected during overnight screening oximetry.
• Many insurance companies are authorizing limited channel monitoring to define and treat OSA.
The polysomnogram is reserved for more complicated cases.
• Portable sleep study in the home setting might also be used.

5. Common complications of OSA would include:

Stroke
Right-sided heart failure
Cardiac dysrhythmias
Hypertension not Hypotension is a common complication of OSA. And although many patients who suffer from OSA have comorbidities like COPD, there is nothing that links one causing the other.
Overlap syndrome is a term which specifies the existence of both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) in the same patient. The prevalence of OSA in COPD patients equals its prevalence in the general population. Overlap patients have a greater degree of hypoxemia and hypercapnea than COPD patients matched for stage. They also have a greater prevalence of pulmonary hypertension and right heart failure, and suffer higher morbidity. Due to these consequences of the overlap syndrome, it is recommended to actively search for its existence in COPD patients, and to treat it with continuous positive airway pressure (CPAP) concurrently with oxygen and optimal pharmacological treatment of COPD. (Shteinberg M, 2009)
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, 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.

6. Polysomnography, also called a sleep study, is a test used to diagnose sleep disorders. Polysomnography records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements during the study. Your doctor may ask you not to drink alcohol or eat or drink anything with caffeine during the afternoon and evening before polysomnography. Alcohol and caffeine can change your sleep patterns, and they may make symptoms of some sleep disorders worse. Explain to the patient that continuous monitoring will take place and the person doing the sleep study may have you put on a CPAP device.
A polysomnogram will determine 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, Sp O 2 , 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
7.
* Losing weight * Exercising * Avoiding alcohol and medications such as tranquilizers and sleeping pills. * Sleeping on your side or abdomen rather than on your back * Keeping your nasal passages open while you sleep. * Smoking cessation
• Begin efforts to lose weight. He could immediately begin a walking program and start an appropriate diet.
• Abstain from alcohol.
• 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.
• Avoid opioids, benzodiazepines, muscle relaxants.
• Elevate the head of bed (HOB).
• Initiate smoking cessation efforts. He can enroll in a smoking cessation program, use nicotine patches, gum, or a prescription for bupropion (Zyban) to help him stop smoking.
• Decrease caffeine intake. He can start mixing his coffee with decaffeinated coffee to decrease the caffeine. 8. Treatment options for OSA:

If lifestyle changes aren’t enough for the patient the physician may recommend more aggressive forms of treatment.
Positive Airway Pressure - In this treatment, a machine delivers air pressure through a piece that fits into the nose or is placed over the nose and mouth while you sleep.
Positive airway pressure reduces the number of respiratory events that occur as you sleep, reduces daytime sleepiness and improves your quality of life.
The most common type is called continuous positive airway pressure, or CPAP (SEE-pap). With this treatment, the pressure of the air breathed is continuous, constant and somewhat greater than that of the surrounding air, which is just enough to keep your upper airway passages open. This air pressure prevents obstructive sleep apnea and snoring.
Uvulopalatopharyngoplasty (UPPP) is a procedure in which your doctor removes tissue from the back of your mouth and top of your throat. Your tonsils and adenoids are commonly removed as well.
Use of a mouthpiece or certain medications may also be prescribed.
Appliances : Mild OSA can be treated using dental appliances that move and hold the mandible in a forward position.
Continuous positive airway pressure (CPAP) : A machine generates a continuous flow of air to the upper airways throughout the respiratory cycle. The airflow is delivered with sufficient pressure to prevent the upper airway from collapsing during inspiration. This method can be used through a ventilator, endotracheal tube, nasal pillow, nasal mask, or full face mask.
CPAP with O 2 : This is the same as CPAP but with added O 2 through the machine or by nasal cannula.
This method can be used with a nasal pillow, nasal mask, or full face mask.
BiPAP: The mask fits over both the mouth and nose.
SURGICAL OPTIONS
Tonsillectomy, with or without adenoidectomy, or a uvulopalatopharyngoplasty (UPPP) (the removal of the uvula, part of the soft palate, and mucosa of the pharynx) might be done to enlarge the throat. Reports of success vary widely, from 40% to 80%.
Mandibular advancement surgery for the congenital small mandible can be performed.
Tracheostomy : This surgical procedure creates an artificial opening into the trachea from the neck. The patient places a cap over the opening during the day, allowing the patient to breathe and speak normally. The patient connects himself or herself to humidified O 2 at night, thereby bypassing any upper airway obstruction. This treatment option is reserved for life-threatening sleep apnea.
Bariatric surgery might be considered in the efforts to facilitate weight loss, therefore improving symptoms of OSA.

9. If you're having difficulties tolerating pressure, some machines have special adaptive pressure functions to improve comfort. You may have to check your machine settings. You also may benefit from using a humidifier along with your CPAP system. You can also use certain lubricants for dryness and cushions for the nose and ears to prevent sores from forming. Check the face mask to make sure it’s not too tight. Assess regularly.
• Instruct him to ask the DME company to check the mask and tubing to make sure they are fitting properly.
• Instruct him to ask the company to add humidification to his O 2 .
• Get saline nasal spray at any drugstore or make your own. Use two sprays in each nostril up to q2h prn. A recipe for ocean saline spray: Boil water 20 minutes and let cool. Then to 1 quart water, add
1 tsp salt, plus a pinch of baking soda. Store at room temperature in a covered container for up to
72 hours, then discard.
• Teach S.R. how to pad and protect the skin behind his ears.
• Have him gently cleanse the nares every 8 hours with a cotton-tipped applicator moistened with saline.

Evelyn, great job on your first case study, very thorough. Next time please type the question before the answer. Thank you!
Grade; 93%