Sleep apnea: A challenge in critical care

Sleep apnea, defined as the cessation of breathing for at least 10 seconds during sleep, can have detrimental effects on the critically ill. Three types of sleep apnea exist, the most common being obstructive sleep apnea. Though its prevalence is only 1% to 3% in adults, it is very important to diagnose it and treat it early in the critically ill because it causes respiratory failure and difficult weaning from mechanical ventilation. Its most characteristic manifestations are repetitive apneic episodes during sleep, snoring, and diurnal hypersomnolence. Complications of sleep apnea include dysrhythmias, systemic and pulmonary hypertension, hypoxia, hypoventilation, left ventricular dysfunction, and stroke. Treatment methods depend on the cause and include medications, surgery, and nasal continuous positive airway pressure. The main nursing role is astute assessment and early detection, proper respiratory management, provision of psychologic support, and patient and family teaching.