Obstructive Sleep Apnea Syndrome: Quality Sleep

Esra BAŞER AKINa , Mukadder MOLLAOĞLUa
aSivas Cumhuriyet University Faculty of Health Science, Department of Nursing, Department of Internal Medicine Nursing, Sivas, Türkiye

Başer Akın E, Mollaoğlu M. Obstructive sleep apnea syndrome: Quality sleep. In: Çevik Akyıl R, ed. Nursing Approach in Respiratory Diseases. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.31- 42.

ABSTRACT
Obstructive sleep apnea syndrome (OSAS) is the most common cause of sleep disorder in which oxygen saturation decreases, causing sleep apnea and hypoapnea attacks, which reduces sleep quality. The incidence of the disease increases with body mass index (BMI), alcohol and cigarette use, and male gender. Obstructive sleep apnea syndrome causes the individual to experience insomnia and narcolepsy, negatively affecting the quality of sleep and indirectly the quality of life. Frequent awakenings, apnea attacks, and low oxygen levels during night sleep cause sleepiness, fatigue, and difficulty in continuing life activities in individuals during the day. Methods such as surgery and lifestyle changes are used in the treatment of the disease. Nurses have important responsibilities in reducing the symptoms experienced by OSAS patients and regulating sleep quality. In this review, treatment and nursing interventions necessary for quality sleep in individuals who develop OSAS are discussed.

Keywords: Sleep apnea syndrome; sleep; sleep disorders; sleep hygiene; nursing

Referanslar

  1. Kayabekir M. Uykuda solunum bozukluğu şikayeti olan 60-75 yaş arasındaki yaşlı bireylerde aşırı kilo/obezite ve obstrüktif uyku apne sendromu arasındaki epidemiyolojik ilişki. Dicle Med J. 2021;48(2):260-6. [Crossref]
  2. Slowik JM, Collen JF. Obstructive sleep apnea. In StatPearls. StatPearls Publishing. 2022.Erişim: 29.12.2023. [Link]
  3. Yıldırım A, Tekeşin AK. Obstrüktif Uyku Apne Sendromu Olan Hastalarda Klinik ve Demografik Verilerinin Değerlendirilmesi. [Evaluation of Clinical and Demographic Data in Patients with Obstructive Sleep Apnea Syndrome] Sakarya Medical Journal. 2021;11(1):103-8. [Crossref]
  4. Memon J, Manganaro SN. Obstructive sleep-disordered breathing. In StatPearls. StatPearls Publishing, 2021 Erişim: 29.12.2023 [Link]
  5. Acharya A, Man Shrestha R, Thapa P, Adhikari D. Obstructive sleep apnea syndrome - a scoping review. JKDC. 2020;(1):1.
  6. Hirani R. Smiley, A. A Scoping Review of Sleep Apnea: where Do we Stand? Life.2023;13:387. [Crossref]  [PubMed]  [PMC]
  7. Uslu Y, Demir Korkmaz F. Yoğun bakım hastalarında uyku: Hemşirelik bakımı. [Intensive Care Patients Sleep: Nursing Care]. JERN. 2015;12(3):156-61.
  8. Yıldızeli Topçu S. Hastaların solunum egzersizi uygulamalarını etkileyen faktörler ve hemşirelerin rolü. JICH. 2016;2.
  9. Kaçmaz Başoğlu Ö. Obstrüktif Uyku Apne Senromu, Klinik Özellikleri ve Tanısı. Turkiye Klinikleri J Pulm Med-Special Topics. 2017;10(1):7-13.
  10. Miyahara LK, Stefanini R, Suguri VM, wawginiak GH, Balsalobre RA, Haddad FLM. Evaluation of sleep quality and risk of obstructive sleep apnea in patients referred for aesthetic rhinoplasty. Sleep Sci. 2019;12(3):126-31. [Crossref]  [PubMed]  [PMC]
  11. American Academy of Sleep Medicine. International classification of sleep disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014. p.53-62.
  12. Yaggi HK, Strohl KP. Adult obstructive sleep apnea/hypopnea syndrome: definitions, risk factors, and pathogenesis. Clin Chest Med. 2010;31(2):179-86. [Crossref]  [PubMed]
  13. Johnson DA, Guo N, Rueschman M, wang R, wilson JG, Redline S. Prevalence and correlates of obstructive sleep apnea among african americans: The jackson heart sleep study. Sleep. 2018;41(10):1-9. [Crossref]  [PubMed]  [PMC]
  14. Peppard PE, Young T, Barnet JH, Palta M, Hagen Ew, Hla KM. Increased prevalence of sleep disordered breathing in adults. Am J Epidemiol.2013;177(9):1006-14. [Crossref]  [PubMed]  [PMC]
  15. Şenel GB, Ağan K, Sünter G, Aktaç Ş, Karadeniz D, Koşunda A. ve ark. Obstrüktif uyku apne sendromu ile diyabet ilişkisinin antropometrik ölçümlere göre incelenmesi. J Turk Sleep Med. 2020;11-6.
  16. Kline CE, Irish LA, Krafty RT, Sternfeld B, Kravitz HM, Buysse DJ., et al. Consistently high sports/exercise activity is associated with better sleep quality, continuity and depth in mildlife women: the SwAN Sleep Study. Sleep.2013;36(9):1279-88. [Crossref]  [PubMed]  [PMC]
  17. Newman AB, Foster G, Givelber R, Nieto FJ, Redline S, Young T. Progression and regression of sleep-disordered breathing with changes in weight: The Sleep Heart Health Study. Arch Intern Med. 2005;165:2408-13. [Crossref]  [PubMed]
  18. Mukherjee S, Saxena R, Palmer LJ. The genetics of obstructive sleep apnea. Respirology. 2018;2:318-27.
  19. Kim Sw, Taranto-Montemurro L. when do gender differences begin in obstructive sleep apnea patients? J Thorac Dis. 2019;11(Suppl. 9):1147-9. [Crossref]  [PubMed]  [PMC]
  20. Liao Y, xie L, Chen x, Kelly BC, Qi C, Pan C, et al. Sleep quality in cigarette smokers and nonsmokers: Findings from the general population in central China. BMC Public Health. 2019;19:808. [Crossref]  [PubMed]  [PMC]
  21. Mehra R, Gharibeh T. Obstructive sleep apnea syndrome: Natural history, diagnosis, and emerging treatment options. Nat Sci Sleep. 2010;2:233-55. [Crossref]  [PubMed]  [PMC]
  22. Sozer V, Kutnu M, Atahan E, Ozturk BC, Hysi E, Cabuk C, et al. Changes in inflammatory mediators as a result of intermittent hypoxia in obstructive sleep apnea syndrome. Clin Respir J. 2017;12:1615-22. [Crossref]  [PubMed]
  23. Benbir Şenel G. Horlama ve Tıkayıcı Uyku Apne Sendromunda Fizyopatoloji, Bulgu ve Semptomlar. Özkul MH, editör. Çok Seviyeli Cerrahi Yöntemlerle Tıkayıcı Uyku Apnesi Tedavisi. Ankara: Türkiye Klinikleri; 2018. p.1-8.
  24. Verbraecken J, De Backer w. Upper airway mechanics. Respiration.2009;78:121-33. [Crossref]  [PubMed]  [PMC]
  25. White DP. Advanced concepts in the Pathophysiology of Obstructive Sleep Apnea. Adv Otorhinolaryngol. 2017;80:7-16. [Crossref]  [PubMed]
  26. Patil SP, Schneider H, Marx JJ, Gladmon E, Schwartz AR, Smith PL. Neuromechanical control of upper airway patency during sleep. J Appl Physiol. (1985). 2007;102(2):547-56. [Crossref]  [PubMed]
  27. Serçe S, Ovayolu Ö. Obstrüktif Uyku Apne Sendromunda Giyilebilir Teknolojinin Yorgunluk ve Gündüz Uykululuğuna Etkisi: Literatür İncelemesi. Value Health Sci. 2024;14:163-67. [Crossref]
  28. Patel SR. Obstructive Sleep Apnea. Ann Int Med. 2019;171(11):81-6. [Crossref]  [PubMed]
  29. Johns Mw. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-5. [Crossref]  [PubMed]
  30. Carskadon M, Dernent w, Mitler M, et al. Guidelines for the multiple sleep latency test (MSLT): a standard measure of sleepiness. Sleep. 1986;9:519524. [Crossref]  [PubMed]
  31. Lee JJ, Sundar KM. Evaluation and Management of Adults with Obstructive Sleep Apnea Syndrome. Lung. 2021;199:87-101. [Crossref]  [PubMed]
  32. Randerath w, Bonsignore MR, Herkenrath S. Obstructive sleep apnoea in acute coronary syndrome. Eur Respir Rev. 2019;28(153):180114. [Crossref]  [PubMed]  [PMC]
  33. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet. 2014;383(9918):736-47. [Crossref]  [PubMed]
  34. Song SO, He K, Narla RR, Kang HG, Ryu HU, Boyko EJ. Metabolic Consequences of Obstructive Sleep Apnea Especially Pertaining to Diabetes Mellitus and Insulin Sensitivity. Diabetes Metab J. 2019;43(2):144-55. [Crossref]  [PubMed]  [PMC]
  35. Gottlieb DJ, Punjabi NM. Diagnosis and Management of Obstructive Sleep Apnea: A Review. JAMA. 2020;323(14):1389-400. [Crossref]  [PubMed]
  36. Uçar E, Nagaş, IÇ. Obstrüktif Uyku Apne Sendromunda Tanı ve Tedavi Yöntemlerinde Güncel Yaklaşımlar. The Journal of Ege University School of Dentistry. 2021;42(1):37-48. [Crossref]
  37. Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017;13(3):479-504. [Crossref]  [PubMed]  [PMC]
  38. Tauman R, et al. watch-PAT is useful in the diagnosis of sleep apnea in patients with atrial fbrillation. Nat Sci Sleep. 2020;12:1115-21. [Crossref]  [PubMed]  [PMC]
  39. Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG.Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure: An American 93 Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment.J Clin Sleep Med. 2019;15(2):301-34. [Crossref]  [PubMed]  [PMC]
  40. Rapelli G, Pietrabissa G, Manzoni GM, Bastoni I, Scarpina F, Tovaglieri I, etal. Improving CPAP Adherence in Adults with Obstructive Sleep Apnea Syndrome: A Scoping Review of Motivational Interventions. Front. Psychol. 2021;12:705364. [Crossref]  [PubMed]  [PMC]
  41. Zhu Y, Long H, Jian F, Lin J, Zhu J, Gao M, et al. The effectiveness of oral appliances for obstructive sleep apnea syndrome: A meta-analysis. J Dent. 2015;43(12):1394-402. [Crossref]  [PubMed]
  42. Trakada G, Chrousos G, Pejovic S, Vgontzas A. Sleep Apnea and its association with the Stress System, Inflammation, Insulin Resistance and Visceral Obesity. Sleep Med Clin. 2007;2(2):251-61. [Crossref]  [PubMed]  [PMC]
  43. Tietjens JR, Claman D, Kezirian EJ, De Marco T, Mirzayan A, Sadroonri B, et al. Obstructive Sleep Apnea in Cardiovascular Disease: A Review of the Literature and Proposed Multidisciplinary Clinical Management Strategy. J Am Heart Assoc. 2019:8:e010440. [Crossref]  [PubMed]  [PMC]
  44. Brill AK, Horvath T, Seiler A, Camilo M, Haynes AG, Ott SR, et al. CPAP as treatment of sleep apnea after stroke: A meta-analysis of randomized trials. Neurology. 2018;90:e1222-30. [Crossref]  [PubMed]
  45. Spałka J, Kędzia K, Kuczyński w, Kudrycka A, Małolepsza A, Białasiewicz P, et al. Morning Headache as an Obstructive Sleep Apnea-Related Symptom among Sleep Clinic Patients-A Cross-Section Analysis. Brain Sci.2020;10(1):57. [Crossref]  [PubMed]  [PMC]
  46. Tang R, Li C, Di D, Zhou L, Qian Y, Qiang C, et al. Evaluate the Relationship Between Obstructive Sleep Apnea and Metabolic Syndrome in Real-world Data. Nat Sci Sleep. 2024;16:217-31. [Crossref]  [PubMed]  [PMC]
  47. Yu Z, Cheng Jx, Zhang D, Yi F, Ji Q. Association between Obstructive Sleep Apnea and Type 2 Diabetes Mellitus: A Dose-Response Meta-Analysis. Evid Based Complement Alternat Med. 2021;2021:1337118. [Crossref]  [PubMed]  [PMC]
  48. Drager LF, Jun J, Polotsky VY. Obstructive sleep apnea and dyslipidemia: Implications for atherosclerosis. Curr. Opin. Endocrinol. Diabetes.2010;17:161-5. [Crossref]  [PubMed]  [PMC]
  49. Aydın Ş, Özdemir C. Obstrüktif Uyku Apne Sendromu Tanı ve Tedavisinde Güncel Güçlükler. Turkiye Klinikleri J Pulm Med-Special Topics.2018;11(2):161-7.
  50. Abbasi A, et al. A comprehensive review of obstructive sleep apnea. Sleep Sci. 2021;14(2):142. [Crossref]
  51. Kabeloğlu V, Reyhanı A. REM Uyku Evresi ile İlişkili Obstrüktif Uyku Apne Sendromu ile Pozisyonel Obstrüktif Uyku Apne Sendromu Hastalarının Klinik ve Polisomnografik Olarak Karşılaştırılması. J Turk Sleep Med. 2021:8.3.
  52. Dijk DJ, Landolt HP. Sleep physiology, circadian rhythms, waking performance and the development of sleep-wake therapeutics. Handb Exp Pharmacol. 2019:441-81. [Crossref]  [PubMed]
  53. Kabeloğlu V, Öztürk O. Obtrüktif Uyku Apne Sendromu Şiddetine Antropometrik Parametre Cinsiyet ve Uyku Pozisyonunun Etkisi. Uludağ Üniversitesi Tıp Fakültesi Dergisi. 2021;47(3):335-9. [Crossref]
  54. Hacı C, Açıkalın RM, Gezginadam Z, Coşkun SÇ, Yanık HT, Yaşar H. Uyku apnesi hastalarında gündüz aşırı uykululuk halinin değerlendirilmesi ve hayat kalitesi ile olan ilişkisinin saptanması. Med Bull Haseki. 2019;57:79-84. [Crossref]
  55. Yalçın A, Saygın M. Koku ve Uyku Kalitesi İlişkisinin Araştırılması. Slep Bult.2021;2(2):38-48.
  56. Çetinol T, Özvurmaz S. Hemşirelerde Uyku Kalitesi ve İlişkili Faktörler. Medical Sciences. 2018;13(4):80-9. [Crossref]
  57. MacLean Aw, Fekken GC, Saskin P, Knowles JB. Psychometric evaluation of the Stanford Sleepiness Scale. J Sleep Res. 1992;1:35-9. [Crossref]  [PubMed]
  58. Ağargün, M, Çilli A, Kara H, Bilici M, Telcioğlu M, Semiz Ü, et al. Epworth Uykululuk Ölçeği'nin Geçerliği ve Güvenirliği. Türk Psikiyatri Dergisi. 1999;10(4):261-7.
  59. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann. Intern. Med. 1999;131(7):485-91. [Crossref]  [PubMed]
  60. Ulaşlı SS, Gunay E, Koyuncu T, Akar O, Halıcı B, Ulu S, et al. Predictive value of Belin Questionnaire and Epworth Sleepiness Scale for obstructive sleep apnea in a sleep clinic population. Clin Respir J. 2014;8(3):292-6. [Crossref]  [PubMed]
  61. Buysse DJ, Reynolds CF, Timothy HM, Susan RB, David JK. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1988;28:193-213. [Crossref]  [PubMed]
  62. Ağargün MY, Kara H, Anlar O. The validity and reliability of the Pittsburgh Sleep Quality Index. Turkish Psychiatry J. 1996;7(2):107-15.
  63. Senthilvel E, Auckley D, Dasarathy J. Evaluation of sleep disorders in the primary care setting: history taking compared to questionnaires. J Clin Sleep Med. 2011;7:41-8. [Crossref]  [PubMed]  [PMC]
  64. Chung F, Subramanyam R, Liao P et al. High STOP-Bang score indicates a high probability of obstructive sleep apnea. Br J Anaesth. 2012;108:768-75. [Crossref]  [PubMed]  [PMC]
  65. Saza S, Çevik K. KOAH tanısı almış hastalara uygulanan progresif gevşeme egzersizlerinin yorgunluk ve yaşam kalitesine etkisi. Cukurova Med J. 2020;45(2):662-71. [Crossref]
  66. Bellon F, Mora-Noya V, Pastells-Peiró R, Abad-Corpa E, Gea-Sánchez M, Moreno-Casbas T. The efficacy of nursing interventions on sleep quality in hospitalized patients: a systematic review of randomized controlled trials. Int J Nurs Stud. 2021;115:103855. [Crossref]  [PubMed]
  67. Güngör Tavşanlı N, Akgün S. Gebeliğin Başlangıcındaki Kadınlarda Uyku Hijyeni Eğitiminin Uyku Kalitesine Etkisi. International Anatolia Academic Online Journal Health Sciences. 2021;7(2):93-108.
  68. Güneş Z. Uyku Sağlığının Korunmasında Uyku Hijyenin Rolü ve Stratejileri. Archives Medical Review Journal. 2018;27(2):188-98. [Crossref]
  69. Cumpston E, Chen P. Sleep Apnea Syndrome. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Erişim: 15.02.2024. [Link]
  70. Peng J, Yuan Y, Zhao Y, Ren H. Effects of Exercise on Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022;19(17):10845. [Crossref]  [PubMed]  [PMC]
  71. Akashiba T, Inoue Y, Uchimura N, Ohi M, Kasai T, Kawana F, et al. Sleep apnea syndrome (SAS) clinical practice guidelines 2020. Respiratory Investigation. 2022;60(1):3-32. [Crossref]  [PubMed]
  72. Jackson M, Collins A, Berlowitz D, Howard M, O'Donoghue F, Barnes F. Efficacy of sleep position modification to treat positional obstructive sleep apnea Sleep Med. 2015;16:545-52. [Crossref]  [PubMed]
  73. Carneiro-Barrera A, Amaro-Gahete FJ, Guillén-Riquelme A, Jurado-Fasoli L, Sáez-Roca G, Martín-Carrasco C, et al. Effect of an interdisciplinary weight loss and lifestyle intervention on obstructive sleep apnea severity: the INTERAPNEA randomized clinical trial. JAMA Netw. Open. 2022;5(4):228212-228212. [Crossref]  [PubMed]  [PMC]
  74. Pazarl AC. Uyku Apne Sendromunda Gelecek: Teletıp. Turkiye Klinikleri Arch Lung. 2023;22.2. [Crossref]
  75. van der Kleij S, de Backer I, Hanraets B, Verbraecken J, Asin J. Effectiveness of remote monitoring in improving CPAP compliance and the impact of preexisting organisation of standard care: a randomised controlled trial. Sleep breath. 2024;28(4):1715-21. [Crossref]  [PubMed]  [PMC]
  76. Yeh E, wong E, Tsai Cw, Gu w, Chen PL, Leung L, et al. Detection of obstructive sleep apnea using belun sleep platform wearable with neural network-based algorithm and its combined use with stop-bang questionnaire. PloS One. 2021;16(10):1-15. [Crossref]  [PubMed]  [PMC]
  77. Kim Jw, Ryu B, Cho S, Heo E, Kim Y, Lee J. et al. Impact of personal health records and wearables on health outcomes and patient response: three-arm randomized controlled trial. JMIR mHealth and uHealth.2019;7(1):1-13. [Crossref]  [PubMed]  [PMC]
  78. Iftikhar IH, Kline CE, Youngstedt SD. Effects of exercise training on sleep apnea: a meta-analysis. Lung. 2014;192(1):175-84. [Crossref]  [PubMed]  [PMC]