Course Work


ObstructiveSleep Apnoea has been described as a medical condition which happenswhen the throat muscles relax during sleep. The result is a completeobstruction and restriction of the airway thus causing apnoea. Thebrain is thus alerted, and the person has to wake up to restore hisbreathing pattern. Its severity is measured by the Apnoea/ HypopnoeaIndex which is used to record the quantity of typical episodesexperienced per hour. An effective treatment developed for thiscondition is the use of a Continuous Positive Airway Pressure (CPAP)device. The mechanism of action is that this device supports thepalate and inhibits collapse that leads to apnoeic episodes. Air isdelivered through a mask or a nasal cannula.


While conductingCPAP clinical trials on patients that have been diagnosed withObstructive Sleep Apnoea, there is a greater need to maintain highlevels of research ethics. According to the Helsinki Declaration,protection of participants that make the subjects of clinical trialsis very crucial. In conducting such clinical trials, it should benoted that participants should never be exposed to any health riskfrom any of the regimens being used as treatment. Physicians shouldhave a good reason for the participation of the subject in theresearch as not to affect his or her health. Doctors involved in themedical research have a duty to protect the life and health of thesubject involved in the trial. This means that the responsibility ofprotecting research subjects does not lie with the subjects but thehealth professionals conducting the research. However, for thispresented case, the medical professionals conducting the research arefaced with a problem of denying a certain control group a treatmenteven though this treatment is suspected to be having potentialbenefits in dealing with Obstructive Sleep Apnoea. The researchershave to, therefore, deal with this problem bearing in mind the needto uphold the research ethics.

Reviewof Literature

Obstructivesleep apnoea occurs when the trachea collapses during sleep times. Itmakes the person experience episodes of respiratory distress withreduced ventilation levels which can lead to body hypoxia.Obstructive Sleep Apnoea normally presents with some other problemslike Cardiac Arrhythmias, transient ischemic attacks and evencoronary heart disease (Shah N, 2013). There has been some variousresearch conducted, but many of them have been restricted in regardfor ethical concerns for longer periods.

There are somesimilarities between an Obstructive Sleep Apnoea and insomnia.Diagnosis will, therefore, be made from clinical examination andhistory. The persons having the problem may not be aware of it, butproblems manifest from his or her disordered sleep patterns evenduring the day. Most of the history of disturbed sleep patterns may,therefore, arise from the partners (Crawford M, 2013).

In any clinicaltrials, some ethical issues must be adhered to. A clinical trial onthe evaluation of the use of a CPAP device and an alternative use ofa placebo should thus be conducted after thorough legal evaluation ofethics. The significance of this is the protection of the rights ofthe subject undergoing the research (Brown &amp Anderson, 2011).

Contribution andRoles Nurses hold in Healthcare

The problem ofsleep apnoea is largely dealt with by primary care, but nurses havebecome highly involved in detecting thesis problems over the visitsand appointments made by the patients. This comes from patientsmentioning their unusual sleeping patterns to the nurses or sleepproblems face by their partners. During hospital visits, nurses arefaced with the duty of explaining to the patients on the questionsthat arise about sleep patterns. Nurses need to be sensitive toproblems of daytime sleep from the history presented by the patients.These are signs of sleep apnoea complications (Malcolm, 2015).

Nurses workingin hospitals have the opportunity to observe patients as they sleep.Unusual waking up and snoring habits suggest an underlying problemand these need to be explored further. Snoring and great night wakesfrom sleep always suggest an underlying breathing problem. The nursesalso have a role in exploring the patient`s sleep patterns at thepoint of admission. This should also be explored during lifestylediscussions held between caregivers and their patients (Widetke,2013).

Considering thatthe nurse understands the severity of sleep apnoea and its treatment,he or she may help the patient in the management of the conditionwhile in the hospital. Some patients are reluctant to bring CPAPequipment to the hospital because they view it as a bother to otherpatients. Nurses, therefore, have a role in assuring such kind ofpatients that their comfort in sleeping patterns is a major treatmentmilestone in their treatment. Demonstration on how to use the CPAPdevice and even prevention of potential problems which includechafing around the nose and a problem of conjunctival edema can beillustrated by the nurse (Malcolm, 2015)

The nurses havea role to help with symptomatic management as a result of ObstructiveSleep Apnoea. Persons affected with sleep apnea have an increasedlikelihood of having elevated blood pressure levels, choking episodeswhile sleeping, decreased libido, and night restlessness. Thesesymptoms can affect relationships, and it is, therefore, of greatimportance that the nurses become the first conduit of deliveringpsychological support and counseling to couples (Billings, 2012).

In lifestylediscussions, common factors worsening obstructive sleep apnoea suchas obesity, smoking and alcohol consumption should be discussed andmeans of avoiding them addressed. This is a big role played by thenurses. Such kind of lifestyle changes is normally very difficult tomake considering that the patients are under a lot of stress.

EthicalIssues and Decisions faced in Healthcare

The healthcareethics are considerate decisions made in treatments and researchwhile taking into consideration the best of wishes of the patientsand even their beliefs. The professionals conducting the research andeven the doctors have to make daily decisions which should beethically correct. There are some written codes of ethics andpolicies which determine the best conduct for all employees. Thepatients and their families have to work with the doctors and nursesto cohesively identify and resolve all the difficult decisions beingmade (Brown &amp Anderson, 2011).

One of the majorethical issues that are faced and tackled in the health care systemis confidentiality. Patient information is a private matter whicharises in the field of health care. All the conversations that areheld between a patient and a health care provider should be held withthe confidentiality they deserve. They should, therefore, besafeguarded (Brown &amp Anderson, 2011).

Patient welfareshould be the main motive that promotes the health care profession.Healthcare providers should, therefore, be honest to the patientsseeking the health care. No patient should be discriminated againstbased on sex, race or any other thing. All the information collectedfrom the patient should be kept private.

Another ethicalissue in health care is the care meted on elderly patients. Elderlypatients may sometimes pose a challenge regarding ethical decisionmaking since these patients can sometimes be a challenge in makingdecisions on their own. This is a difficult task as their familiestake up the responsibility of determining important, difficultdecisions. This is even more difficult in terminally ill patientswhere the family members have to make the difficult decisionsconcerning their health outcome (Brown &amp Anderson, 2011).

Another verygreat ethical issue is on the issue of therapy being given to thepatients. Different techniques and therapies that are given topatients should be focused on a better outcome and alleviation of anyoffending incidents.

GlobalHealthcare Delivery Systems

The globalhealthcare delivery system is depicted in the form of dailyoperations being conducted to manage patient care in a proper andindividualized manner. The system also includes recruitment andselection. For a focused healthcare delivery, the proper andwell-qualified people have to be recruited to take up the tasks ofpatient management.

Training ofhealthcare providers also promotes good patient care. Good trainingwill always equate an improved care and delivery (WHO, 2012).

Availability of aregulatory environment that enhances proper delivery of care topatients without any form of discrimination forms a major backbone ofglobal health delivery. The patient should be in a position to accesshealth care easily and at a low or subsidized cost. (WHO, 2012)


While the mainobjective of the research is to generate new medical knowledge, thisaim can, however, never take precedence over the rights of theresearch subject. When providing medical care, a health care providershould act in the patient’s best interest. Despite a medicalresearch having the best of intentions, any research must follow theethical standards that respect all human subjects and protect theirhealth. Any interventions conducted must be continually evaluated fortheir safety, efficiency, and effectiveness.

Works Cited

Billings, D. (2012). Teaching in Nursing: A guide for faculty. St Louis, MO: Elseiver sanders.

Brown, D., &amp Anderson, C. (2011). Ethical issues in conduct of clinical trials in obstructive sleep apnea. Journal on clinical sleep medicine, 103- 108.

Crawford M, O. (2013). Insomnia and obstructive sleeo apnea . Sleep medicines clinics, 398.

Malcolm, A. (2015). the Nurse role in managing and treating sleep disorders. Nursing Times, 34.

Shah N, K. J. (2013). Effects of Obstructive Sleep Apnea Therapy on Cardiovascular Disease. Sleep Medicine Clinics, 453- 461.

WHO. (2012). Modern health care delivery systems, care coordination and role of hospitals. Copenhagen: World Health Organisation .

Widetke, R. (2013). Adult Obstructive slep Apnoea: taking a patient centered approach. Ameriacn nurse today, 1.