When analgesics are ordered for a client with obstructive sleep apnea (OSA) following surgery, the nurse is most concerned about:
A. Nonsteroidal anti-inflammatory drugs (NSAIDs)
B. Opioids
C. Anticonvulsants
D. Antidepressants
Correct Answer: B. Opioids
Clients with obstructive sleep apnea are particularly sensitive to opioids. Thus the risk of respiratory depression is increased. The nurse must recognize that clients with OSA should start out receiving very low doses of opioids. Patients should be counseled to avoid alcohol, benzodiazepines, opiates, and some antidepressants which may worsen their condition. Most importantly, patients should reflect on the impact of sleep duration and their health, and place a priority on getting at least 7 to 8 hours of sleep per night.
Option A: Surgical removal of enlarged tonsils and adenoids is the most commonly used treatment for OSA. Given the perioperative risk of the intervention and an estimated recurrence rate of up to 20%, there has recently been an increased interest in non-surgical treatment modalities. As the enlarged adenoids and tonsils consist of hypertrophied lymphoid tissue, anti-inflammatory agents have been proposed as a useful non-invasive treatment option in children with OSA.
Option C: Obstructive sleep apnea, a common disorder resulting in sleep disruption and deprivation, is present in as many as 33% of patients with refractory partial epilepsy. In older adults with epilepsy, the presence of sleep apnea is associated with worsening seizure control or late-onset seizures.
Option D: It is thought that tricyclic antidepressants (TCAs) improve OSA by increasing rapid-eye-movement (REM) sleep latency while decreasing the overall amount of time spent in REM sleep. This modification to sleep architecture possibly improves OSA since the condition worsens during REM sleep, especially in overweight patients.
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