Categorized | Sleep Apnea

Does Sleep Apnea Help Or Hurt The Medical System?


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After being heavily involved with sleep medicine and specifically obstructive sleep apnea for quite some time now, I still find myself wondering what costs and benefits does this little niche in medical care really add/subtract?

It’s a very loaded question, that is for sure, and it’s also one where you would probably find much disagreement between doctors, patients, and especially between insurance companies.  So, I’ll try to break down some of the main issues that I see with sleep apnea and how it folds it’s way into the medical world.

Testing:

There are a two main questions that exist with the testing of sleep apnea.

1) Is testing necessary to diagnose obstructive sleep apnea?

2) What is the best method for testing sleep apnea?

To try and tackle the first question of the necessity of the actual sleep study test, it’s not as easy to answer as one might think.  First of all, primary care doctors who make the most initial referrals to outside sleep testing facilities are usually correct with their early suspicion that a particular patient might have obstructive sleep apnea.  In-fact, over 85% of referrals to sleep testing labs come back positive for OSA according to reports from the previous decades.  That’s actually great news, because that means that non “sleep doctors” are very good at picking up the signs and symptoms of when patients might have this sleeping disorder.  On the other hand, without have a sleep study, nobody is going to know right away how severe he patient’s sleep related breathing disorders actually are.  For example, you might have a patient who suffers from OSA but who is very mild in symptoms.  This easily can compare to a patient who suffers from extreme sleep apnea who might end up having a heart attack in just a few days due to the disorder.  Doctors are very good at picking up sleep apnea, however, it is very difficult to guess the severity of someone’s breathing without a full test.

As for deciding on what form of testing is appropriate, that’s a much easier decision.  Between the current possibilities for formally diagnosing a patient with obstructive sleep apnea, the home testing sleep study is by far the best choice in almost every case and scenario.  The simple reason being the costs are so much less compared with in-lab full Polysomnography testing.  And, the results are virtually identical, even though the doctors who own the full sleep labs would like to argue otherwise.  That is simply not the case.

Treatment:

The biggest questions that I have with treatment actually relates to the testing of sleep apnea.  And here is my question:  if doctors are so good at suspecting that patients have sleep apnea, why not skip the diagnostic tests, and send a patient off for treatment right away.  Almost like what happens with patients when they go to the doctor to get treated for a common cold or the flu.  In those cases, the doctor prescribes some medication or treatment, and the patients go right over to the pharmacy and get squared away.

OK OK, this is not apples to apples, yes, I know that, but there is much more to the story.  Here is the deal, many patients have sleep apnea, and they know it.  But many patients don’t actually want to get tested for the disorder.  Instead, they would rather continue living their lives with OSA, and just hack through the symptoms instead of getting the dreaded sleep study.  It’s horrible.  Imagine that, you’d rather subject yourself to a potential heart attack, compared to getting tested and treated and probably having a much better life.  What’s with that?  How can a diagnostic test be so awful that patients are literally scared to death to get it completed?  Very simple, patients don’t like long drawn out diagnostic tests where they have to spend the night in the hospital, especially when it may cost them over $2,000.  That’s the idea here, people don’t like that type of equation, even if it may save their life.

Because the costs and whole set of actions that needs to be taken to get diagnosed with sleep apnea is so cumbersome, patients would rather for go everything altogether.  That’s not idea. And when patients go undiagnosed for sleep apnea, and untreated, they end up costing the healthcare system tens of millions of dollars each year, actually the number is probably in the billions of dollars.  That is awful.

What may end up being a much better idea, and not only in terms of overall health, but also in terms of saving millions of dollars and helping out the healthcare system, would be to simply put all suspected sleep apnea patients directly on CPAP therapy right away, and see how they feel afterwards.  If patients feel much better, then that would be a win.  If they do not see any particular gains, then different approaches could be taken to reduce the symptoms that the doctor noticed in the first place.

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