Emotions in the course of obstructive sleep apnoea vs. nurses’ support

INTRODUCTION

Obstructive sleep apnoea (OSA) is a common [1-4], often unrecognised [5, 6] disease classified as a sleep-disordered breathing disorder.
Risk factors include lifestyle, older age, male gender, peri-menopausal, overweight and obesity [7], neck circumference in men > 43 cm and in women > 40 [8, 9], endocrine disorders [10], smoking [11], curvature of the nasal septum [12], taking opiates, benzodiazepines [13], frequent upper respiratory infections [14], alcohol [11], pregnancy [15], and cardiovascular diseases [7].
Symptoms of OSA include loud snoring [6, 16], apnoeic episodes, frequent episodes of sudden awakening from sleep [17], insomnia [18], and excessive daytime sleepiness [3, 16]. Awakenings may be accompanied by shortness of breath [16, 18] and feelings of anxiety [1, 3, 19]. Others include excessive sweating, irritability, motor agitation, nycturia [16], morning headaches [3, 16], difficulty concentrating and remembering, impotence and libido disorders, as well as a feeling of fatigue upon awakening [17] and dry mouth [20]. Treatment includes conservative and surgical methods [17, 21].
Individuals with OSA may be encounter various emotions and feelings. These feelings and emotions can be related to the chronic disease as well as difficulties or limitations that result from the course of OSA.
Emotions are characterised by dynamics, and their experience is complex [22]. Emotional reactions, such as expressions or gestures, are the result of an individual’s activity and are subject to individual control [23]. It is believed that controlling one’s own emotions is a reflection of emotional maturity [24]. In the course of disease, different emotions are experienced, and therefore it is necessary to define regulatory goals for them. For the negative ones, the goal will be reduction, i.e. prevention of occurrence, shortening of duration, and reduction of intensity [25].
In caring for patients, it is crucial to provide support and respond appropriately to emotional needs. The treatment team should show understanding and support to patients because experiencing respect and understanding for the emotions felt allows for a faster process of confronting the situation [26].
The aim of this study was to understand the emotions and feelings of patients in the course of OSA, the degree of their control, and their opinions on the support of the nursing team during hospitalisation.

MATERIAL AND METHODS

The study used a diagnostic survey, the author’s survey questionnaire, and the Emotional Control Scale (CECS) scale. The questionnaire included questions about sociodemographic variables, health status, course, treatment, and relevance of OSA to daily activities, and questions about support from the nursing team. The CECS allows measurement of subjective control of anger, anxiety, and depression in difficult situations by adults. The overall emotion control index ranges from 21 to 84 points [27]. Statistical analysis was conducted using Statistica software, and the adopted significance level was p < 0.05. The U Mann-Whitney test was used.
The study was conducted from September 2021 to April 2022 in one of the hospitals in the Lesser Poland region. The criteria for inclusion of subjects in the study were a diagnosis of obstructive sleep apnoea, hospitalisation, the possibility of comorbid diseases that do not affect informed voluntary consent to participate in the study, and age over 18 years. The consent of the Bioethics Committee was not required to conduct the research.
The results presented here are an excerpt from a broader study on emotions in obstructive sleep apnoea vs. nurse support.

RESULTS

The study was conducted among 100 individuals. The study group included 34% women and 66% men. The age group of 30-40 years had the largest number of respondents (32%), and the smallest group (8%) were those aged 40-50 years. Urban residents comprised 77% of the subjects, and the economically active accounted for 70% of the total. The smallest percentage were individuals with higher education (15%). A married relationship was confirmed by 86%. Smoking habit was admitted by 13% of the respondents, and chronic diseases affected 29% – the predominant diagnosis was hypertension.
The symptom most frequently observed by others while the subjects slept was loud snoring (99%), apnoea (98%), and sudden awakening from sleep (95%). Reasons for reporting to a physician were most often due to nighttime sleep that did not bring rest (96%), increased daytime sleepiness and fatigue (96%), multiple awakenings during the night and dry mouth (91%), clammy upper body sweats (82%), awakenings combined with a feeling of suffocating or choking (83%), or headache (65%) (Table 1).

RESPONDENTS’ EMOTIONS AND FEELINGS IN RELATION TO CHRONIC OBSTRUCTIVE SLEEP APNOEA

In the area of questions regarding emotions and feelings in relation to the course of OSA, all agreed that they had lost their sense of independence. In addition, most of the respondents felt shame (91%), threat to their lives (84%), and increased nervousness (84%). More than half of the respondents (58%) had difficulty determining whether they were showing their emotions because of their disease (Table 2).

SUPPORT OF THE NURSING TEAM IN THE OPINION OF RESPONDENTS

Respondents were asked to evaluate the support received from nurses during hospitalisation. For a broader context of showing support during hospitalisation, the results were presented in relation to sources other than just nurses.
Respondents most often identified family (88%), medical staff (87%), and a psychologist (5%) as their sources of support for their disease during hospitalisation. The “medical staff” option was not differentiated by physician or nurse.
The respondents were able to evaluate the overall dimension of support from the nursing team on the basis of one of the questions from the author’s survey questionnaire on a multi-level scale. The results are as follows: support rated high (82%), support rated very high (7%), support rated low (3%), and support rated very low (1%). The remaining individuals had difficulty in evaluating the support shown to them by the nurses.

RESULTS BASED ON THE CECS QUESTIONNAIRE

The CECS questionnaire was used to determine the patients’ level of emotional control. The respondents scored between 39 and 74 points. The highest standard deviation values were observed for anger (2.77). The overall emotion control index was 61.79 (Table 3).
Detailed analysis showed that women scored significantly higher than men on anxiety control (p < 0.05). The control of anger and depression was not significantly different in the study group by gender. In terms of anger, depression, and anxiety control, the subjects did not differ by educational level, marital status, place of residence, or occupational activity.
No significant relationship was confirmed between emotion control and evaluation of the nursing team’s support level:
• no significant relationship was confirmed between anger and level of support from the nursing team (p = 0.452),
• no significant relationship was confirmed between depression and level of support from the nursing team (p = 0.328),
• no significant relationship was confirmed between anxiety and level of support from the nursing team (p = 0.359).

DISCUSSION

Chronic disease is a difficult situation, which makes similar demands and leads to comparable consequences, but it is considered as an individual patient’s struggle with the symptoms and consequences of his own illness. The emotional response to the onset of disease is individual, but the degree of adaptation to a new situation changed by disease is also dependent on the medical staff’s management [28].
Chronic diseases contribute to prolonged emotional tension associated with feelings of life-threatening uncertainty or reduced mood [28]. Our own research showed that patients also experienced negative emotions, feeling mainly shame, increased nervousness, and a threat to life. What is particularly noteworthy is the sense of loss of independence by all subjects.
Studies undertaken by many authors on the issues of OSA have also included issues of experienced emotions and mood in relation to the disease. It turns out that the course of OSA was associated with the subjects’ experience of anxiety, as shown by Ye et al. [29], Alkilinc et al. [19], Lee et al. [30], He et al. [1], and Garbarino et al. in a systematic review in which the prevalence of anxiety ranged from 2.9% to 70% [31].
In contrast, a study conducted by Wong et al. found OSA to be associated with the presence of stress [32], and the same was shown in a study by Shyamsukha et al. The level of perceived stress was rated by respondents as moderate or severe [33].
According to our study, 52% of the respondents admitted mental health deterioration due to obstructive sleep apnoea. Mental health disorders were also indicated by other authors and most often involved depressive symptoms [26, 31, 34-36]. The results of a meta-analysis conducted by Garbarino et al. found that the prevalence of depressive symptoms among people with OSA was 35% [31]. Decreased mood was also confirmed among participants in a study by Ye et al. [29]. Noting that anxiety and depressive disorders are more common in patients with OSA than in the general population, some authors indicate that there is a positive correlation between the severity of sleep apnoea and depressive and anxiety symptoms [28, 32, 37, 38], but there are also reports of the lack of the above relationship or the presence of a negative correlation of apnoea with depressive and anxiety symptoms [30]. There are studies in which OSA is a risk factor for reduced mood and depression that will occur in the future [34]. The results of a review by Velescu et al. point toward the need for evaluation of mental status in the course of OSA [39]. It is also emphasised that proper identification of the causes of mood disorders would allow avoidance of pharmacotherapy with antidepressants among patients with OSA [3]. It is worth noting that the intensity and quality of emotions are variable over time [40].
Other researchers point to a higher prevalence of depressive and anxiety disorders in patients additionally burdened by comorbid diseases [41]. The presence of comorbid diseases was also confirmed in the study group, but analysis of the relationship between these variables was not the subject of our study.
More than half of the subjects (58%) – which may seem unusual – had difficulty relating to the statement “I don’t show my emotions”. However, the ability to speak or define their own emotions is not an obvious issue. In comparison, similar conclusions were made by Nikolaou et al. Individuals with OSB showed more difficulty naming their emotional states than the general population [42]. The mood dysregulation hypothesis in OSA predicts that the prevalence of alexithymia will be higher in these patients, even in the lack of clinically significant affective symptoms [42].
Individualised treatment [43], focused observation [44], understanding, and support are crucial in patient care [45]. Support is a special kind of help for patients to mobilise their resources to cope with disease [46]. The specifics of nurses’ work and professional competence give them the opportunity to play the role of significant persons in providing support in adapting to the disease and in the patient’s exercise of hope. Despite their competence, nurses also rely on intuitive recognition of the patient’s expectations in providing support [47].
Our own research has confirmed the significant impact of OSA on patients’ lives in the area of emotions and feelings. However, it should be noted that the study was conducted during the period of restrictions related to the SARS-CoV-2 virus pandemic, and therefore it is worth keeping in mind that the subjective sense of mental deterioration among the subjects may have been influenced by many factors including social isolation and the atmosphere associated with the pandemic.
Emotions indicate the importance of a particular situation and give them meaning. Experiencing them triggers an individual’s reactions, ranging from activation to inhibition of their activity. Their role is diverse and present in adapting to the environment and shaping relationships with others and self-image [40]. Self-control mechanisms take place at different levels, resulting in a change in the expression and disclosure of experiencing emotions [40].
Given the confirmed prevalence of psychological problems among patients with OSA, there is a need for the treatment team, including nurses, to show sensitivity toward evaluating the mental state of patients. Experiencing this disease, which may seem “not serious” at first sight, along with the patients’ understanding of their own situation, can show them the multifaceted consequences of OSA and condition their emotions, the nature of which may be variable. These emotions can be related not only to the perception of oneself as an individual, but also to oneself in relationships and social interactions, as our research has shown, among others. Therefore, evaluation of emotions, and their intensity and mood at different stages of the disease can and should be carried out because this determines additional therapeutic interventions, focused not only on the physical complaints and symptoms of the disease. The situation of making interventions in the psychological area seems to be easier if the patient is capable of verbalising emotions, but unfortunately – for various reasons – not all patients have this ability, which is why special attention and support should be directed to this group of patients.

CONCLUSIONS

Obstructive sleep apnoea contributes to the feeling of many emotions, including shame, threat to life, increased nervousness, and, in all subjects, a sense of loss of independence.
According to the CECS scale, the overall index was 61.79 points, which can be interpreted as an average degree of suppression of negative emotions. The most suppressed emotion was anger. Women scored significantly higher than men on anxiety control.
The overall support of the nursing team rated as high had no relationship with the subjects’ control of emotions.
Nurses’ evaluation of the emotions experienced should be an ongoing element prior to undertaking therapeutic interventions for a patient with a chronic disease.

Disclosures

This research received no external funding.
Institutional review board statement: Not applicable.
The authors declare no conflict of interest.

References