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Scoring your snore could save your life.

Oklahoma City -- Do you snore most nights? Has anyone ever told you that you gasp for breath when you sleep? Do you sometimes doze off during the day? While a little less sleep can leave you tired the next day, chronic sleep problems, in particular sleep apnea, could mean the difference between life and death.

And if you have sleep apnea--a disorder characterized by brief interruptions of breathing during sleep--it could spell trouble if you have surgery. That's why Mercy Health Center is now wired to monitor patients with sleep apnea after they undergo surgery. It's also the reason a group of Mercy anesthesiologists--all board certified--recently urged that guidelines be put into place to determine before surgery whether or not someone might be at risk for sleep apnea. In addition, patients are followed throughout their hospital stay if they are at increased risk.

"When someone is given anesthesia and powerful narcotics in the hospital, they are at an increased risk if they have sleep apnea. With these medicines, the body is less able to awaken during breathing interruptions," said Scott Maxwell, M.D., a Mercy anesthesiologist. "An even greater obstacle is that only about 20 percent of the 12 million Americans with sleep apnea know they have it. That means that 80 percent of people with sleep apnea aren't even aware they have a problem. And here in Oklahoma with a population that has a higher rate of obesity, the chance of having sleep apnea is even greater."

People with sleep apnea actually stop breathing many times in the night and the body has to actually wake itself up to breathe after each of these interruptions. In severe cases of sleep apnea, people have more than 40 episodes of sleep-disordered breathing per hour. Risk factors for sleep apnea include being male, overweight and over 40, although it can affect anyone at any age, even children. Studies show that untreated, sleep apnea can lead to high blood pressure, heart disease and an increased risk during and after surgery.

To ensure people with sleep apnea don't fall through the cracks, Mercy has put new protocols in place. Prior to a surgery at Mercy:

* A registered nurse conducts an extensive patient interview by telephone.

* A "snore score" screening further identifies a patient's risk and helps determine the need for a sleep study and treatment prior to surgery.

* Every patient is re-evaluated by an anesthesiologist on the day of surgery.

After surgery, patients at risk for sleep apnea are monitored just as closely as patients with cardiac arrhythmias. A pulse oximetry device--which monitors the oxygen level--is placed on the patient's finger and the patient is continuously monitored by technologists in a telemetry room.

"It's likely that many hospitals around the country are not identifying patients at risk for sleep apnea and very few are monitoring patients as closely as we are at Mercy," said Dr. Maxwell. "Patients in some hospitals may have a pulse oximetry device placed on their finger and if the patient's oxygen level plummets, an alarm on a little box beside the bed goes off. But the problem with that is that someone has to hear the alarm. With telemetry, someone is always monitoring the patient."

In a 2008 draft of the national patient safety goals for the Joint Commission on Accreditation of Healthcare Organizations, it states that hospitals will be required to screen for obstructive sleep apnea prior to surgical procedures involving anesthesia, as well as develop protocols for before, during and after surgery.

"We already have all of these measures in place," said Dr. Maxwell. "There is a critical need to improve the diagnosis of sleep-disordered breathing in surgical patients to avoid complications during surgery and after surgery.

Mercy Health Center, the only Magnet hospital in Oklahoma and among only 3 percent of hospitals in the nation to be awarded Magnet status, is a member of Mercy Health System of Oklahoma and the Sisters of Mercy Health System. Magnet-designated facilities: report higher patient satisfaction rates, deliver better patient outcomes, provide more nursing care at the bedside of patients and consistently outperform non-magnet organizations.
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Copyright 2007 Gale, Cengage Learning. All rights reserved.

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Title Annotation:ONA News
Publication:Oklahoma Nurse
Geographic Code:1USA
Date:Jun 1, 2007
Words:684
Previous Article:Oklahoma Board of Nursing summary of FY 2006 annual report.
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