Beyond the Technology: Nursing Critically Ill Children on Extracorporeal Organ Support-A Hermeneutic Review of the Literature.

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder in which the upper airway repeatedly narrows or collapses during sleep, causing pauses or reductions in breathing, oxygen desaturation and fragmented sleep. Clinically, it is diagnosed using specialized tools such as polysomnography, when the apnea–hypopnea index (AHI) is ≥ 5 events·h, in the context of compatible symptoms []. In the general adult population, OSA (AHI ≥ 5 events·h) is now estimated to affect roughly 10–30% of adults, with moderate-to-severe disease (AHI ≥ 15 events·h) present in 6–17% [, ]. Prevalence is consistently higher in men than women and escalates with age and adiposity. In cohorts with BMI ≥ 30 kg·m, approximately 40–70% of individuals meet criteria for at least mild OSA (i.e. AHI ≥ 5 events·h) [, ]. Emerging evidence suggests that OSA may be a “sleeping giant” in several sporting contexts: prevalent in certain athlete groups (especially those in contact/collision-based sports), potentially performance-limiting and health-threatening, and largely invisible to routine screening and monitoring. Elite athletes are already recognized as vulnerable to inadequate and irregular sleep, driven by late-night training and/or competition, travel, stress, and congested schedules []. Original studies, narrative reviews and consensus statements show that elite athletes frequently obtain < 7 h sleep per night and report poor sleep quality, with consequent impairments in mood, cognitive function, metabolism, and recovery that are relevant to training adaptation and performance [–]. However, most of this work has focused on behaviorally driven sleep restriction and insomnia-like complaints, rather than sleep-disordered breathing. The assumption that OSA is confined to older, sedentary, obese adults is increasingly untenable. Objective sleep-study data in athletes, although still limited, suggest that OSA is not rare in contact and collision sports. In an elite rugby union team, Dunican et al. [] found that 24% of players had OSA (AHI ≥ 5 events·h). In professional rugby league, Caia et al. [] reported an even higher prevalence: 10 of 22 players (46%) were diagnosed with either mild or moderate OSA using home-based polysomnography, with forwards and Polynesian athletes overrepresented among cases. Extending beyond single-team data, Howarth et al. [] synthesized 14 studies across American football, rugby union, rugby league, ice hockey, and judo, reporting a pooled OSA prevalence of 30% (95% confidence intervals (CI) 24–36%) in contact-sport athletes, exceeding general-population estimates. Notably, elevated prevalence was observed both in current and retired athletes, and in several college American football cohorts, more than half of players met OSA criteria [].