This chapter provides a comprehensive description of sleep-related breathing disorders, which include includes obstructive sleep apnea (OSA), central sleep apnea (CSA), and Cheyne-Stokes breathing (CSB). It also describes sleep-related hypoventilation/hypoxemic syndromes and sleep-related hypoventilation/hypoxemia due to other medical conditions. CSB and CSA are characterized by instability of the respiratory control system that leads to apneic periods without respiratory effort. Sleep-related breathing disorders are characterized by partial or complete cessation of respiration during sleep, oxyhemoglobin desaturation and sleep fragmentation. Sleep-disordered breathing is a chronic condition that has major implications for morbidity, mortality, and quality of life throughout the world. Nurses, in collaboration with other health care providers, have important roles to play in assessment, treatment, and supporting long-term management and evaluation of this chronic condition. The chapter addresses the characteristics, epidemiology, related factors and consequences, pathophysiology, assessment, diagnosis, and treatment of these disorders, and discusses implications for nursing.
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Sleep loss has tremendous societal implications associated with lost productivity, injuries, accidents, and excessive financial costs. This chapter discusses the nature of sleep loss and sleep disorders and their implications for human health and well-being. It reviews the epidemiological and societal consequences of sleep disorders and discusses diagnostic classification systems and their implications for nursing. Sleep loss results from obtaining less sleep than needed and/or fragmented sleep that leads to deprivation of specific sleep stages even in the presence of adequate total sleep. However, chronic sleep deprivation is endemic and contributes to pathophysiology, daytime dysfunction, fatigue, sleepiness, morbidity, injury, mortality, and poor quality of life. Sleep loss, its consequences, and strategies to prevent and/or treat it are important thematic underpinnings in these narratives. Proficiency in the use of relevant sleep diagnostic classification systems is necessary to interdisciplinary collaboration and sleep diagnosis and treatment.
This chapter reviews normal physiological and anatomical changes that occur during pregnancy and discusses common sleep disorders that can occur during pregnancy as well as postpartum. It also discusses the adverse effects of poor sleep on labor and delivery outcomes and reviews postpartum sleep patterns within the context of risk for postpartum depression. The chapter examines the nurses’ role in sleep promotion in relation to sleep hygiene behaviors that can be adapted for pregnant women and new mothers and their families during the first 6 months postpartum. It describes alternative strategies nurses can use to safely promote sleep during perinatal period. Restless legs syndrome (RLS) and sleep-disordered breathing (SDB) or obstructive sleep apnea (OSA) the most critical causes of disturbed sleep during pregnancy and require urgent assessment and referral for effective and non-pharmacologic interventions. The chapter explores sleep during the postpartum period, when women’s experience with sleep deprivation is expected.
This chapter discusses the characteristics of sleep, factors associated with sleep, and evidence-based strategies to promote sleep in acute and critical care settings. It discusses implications for nursing practice and research. Disordered sleep is common in patients hospitalized in demographical and clinically diverse acute and critical care settings. Careful assessment for factors that increase the risk for sleep disturbance and its consequences during hospitalization is needed. Although randomized clinical trials are sparse, the available evidence suggests the promise of multimodal interventions that reduce environmental stimuli or their impact. Given the high prevalence of obstructive sleep apnea (OSA) in the general population and its underdiagnosis, there is a compelling need for assessment and preventative interventions for this condition. Research is needed on the short- and longer-term outcomes of sleep-promoting interventions on patients’ function, quality of life, and morbidity.
This chapter provides practical strategies for nursing care related to sleep promotion and prevention and treatment of sleep disorders in pediatric primary care settings, acute care settings, and schools. In children with sleep disorders, inadequate sleep does not often result in excessive daytime sleepiness, but in behavioral difficulties such as inattention, hyperactivity, cognitive dysfunction, and/or scholastic problems. Nurses who see children in the primary care setting can take an active role in the evaluation and assessment of all children’s sleep health and provide follow-up care and ongoing treatment monitoring for children who have sleep disorders. In the acute care setting, nurses can incorporate regular treatment plans for a child’s sleep disorder during hospitalization and should be aware of potential for obstructive sleep apnea (OSA)-related perioperative complications for children undergoing adenotonsillectomy. School nurses have the opportunity to promote healthy sleep and improve behavior and school performance in children at risk.
This chapter discusses the roles, qualifications, and educational opportunities for advanced practice nurses (APRNs) in specialized sleep practice. It provides exemplars of practice models to illustrate available opportunities. APRNs are well-positioned to develop specialized sleep practices, based on their strong preparation in health assessment, health promotion, and management of episodic and chronic health care conditions in a wide variety of populations and the pressing societal need for an increase in sleep specialists. Their expertise in promoting lifestyle change is a particular strength. Possible roles for APRNS are multidimensional and encompass clinical practice, education, advocacy, and research. Creative models of practice are needed and continue to emerge. While there is a growing cadre of APRNs with specialized sleep practices in a variety of settings, there is a need for more systematic opportunities for education in sleep, chronobiology, and sleep disorders in basic nursing education, graduate school, and continuing education (CE).
Insomnia is a highly prevalent condition that is known to be associated with important pathophysiological, cognitive, and functional consequences. Adults of all ages and all states of health frequently suffer from insomnia. Therefore, nurses are likely to encounter patients with insomnia in many health care and home settings, including primary care, and acute and long-term care settings. Assessment for insomnia should routinely be incorporated into nursing practice in these settings. Although hypnotics are of some use, cognitive behavioral therapy for insomnia (CBT-I) offers the best long-term results in improving sleep and the daytime sequela resulting from poor sleep. Nurse at all levels play an important role in assessment of insomnia, education about the importance of insomnia, and offering strategies for prevention of chronic insomnia. Effective diagnosis, prevention, and treatment of insomnia are likely to have important effects on reducing its deleterious effects on pathophysiology, functional performance, and quality of life.
Narcolepsy is a potentially disabling hypersomnia of central origin that is associated with dysregulation of sleep and waking states. Although less prevalent than some other sleep disorders, such as sleep apnea and insomnia, narcolepsy is very important because studies of this condition have provided scientists with insight into basic mechanisms of sleep-wake regulation. Although the exact cause of narcolepsy is unknown, causes appear to be multifactorial, for example, genetics, infection, stress, and low levels of the brain neurochemical hypocretin. Effective treatments are available and can improve this chronic condition, as well as its negative consequences. This chapter describes the characteristics and consequences of narcolepsy and strategies for assessment and treatment of this sleep disorder, and discusses implications for nursing practice. Nurses and advanced practice nurses, as members of an interdisciplinary team, play important roles in assessment, diagnosis, treatment, and follow-up care.
Disturbed sleep is associated with increased health care utilization and costs, risks to public safety, reduced quality of life, and morbidity and mortality in the general population. This chapter reviews data related to racial and ethnic health disparities in sleep disorders and discusses the implications for nursing. It focuses on American populations for whom there is available data on sleep. Latino, African, and Asian-Americans may be at greater risk to have or to develop sleep disorders, including sleep-disordered breathing, insomnia, and short sleep duration than their Caucasian counterparts. Risk for developing sleep-related comorbidities may be compounded by cultural barriers, language, acculturation, stress, low income, low education, and lack of health insurance. Well-designed studies are needed to adequately and appropriately evaluate the prevalence of sleep disorders and their associations with morbidity, mortality, function, quality of life and to evaluate sleep disorders treatment outcome.
This chapter provides an overview of information related to some of the most prevalent medical disorders associated with sleep problems including the prevalence, consequences, pathophysiology, and treatment. Unfortunately, sleep problems in patients with cardiovascular disease often go unrecognized and untreated. Clinician factors for this problem include lack of awareness of classic symptoms, lack of mechanistic research, and the need for multicenter random clinical trials. Conversely, diabetes is often associated with a variety of symptoms, which may trigger the development of sleep problems. These include anxiety, depression, painful neuropathy, nocturia, and restless legs. Reducing the severity and impact of symptoms has long been an important priority in the management of individuals with cancer. The chapter describes the impact that sleep problems have on the clinical outcomes of human immunodeficiency virus (HIV) /AIDS patients. It discusses a summary of information related to assessment, diagnosis, and follow-up care.