As more and more physicians and patients are becoming aware of the existence and dangers of obstructive sleep apnea, the number of sleep studies being ordered is on the rise. Though these studies have traditionally been conducted in stand alone sleep laboratories or specialized labs within hospital settings, many patients have objected to being required to sleep away from home in an unfamiliar setting with strangers observing them, and insurance companies have objected to the expense that these studies represent. Portable sleep monitors have been available but many have questioned their usefulness and accuracy. But the American College of Physicians has issued new guidelines indicating that the portable sleep monitors are an adequate substitute for the more elaborate laboratory testing, and are acceptable for the diagnosis of obstructive sleep apnea.
The new guidelines are offered by the respected physician association as a result of recommendations that had been made by the Agency for Healthcare Research and Quality. Though they note that the monitors work well enough for most patients, they also indicate that they are not appropriate for patients who have been diagnosed with chronic lung disease, congestive heart failure or neurological disorders. These patients should continue to seek sleep studies within the observational setting of a sleep laboratory.
The co-author of the new guidelines id Dr. Jon-Erik Holty, staff critical care pulmonologist and sleep physician with the VA Palo Alto Health Care System. He indicates that the low cost of the portable monitors is much preferred by health insurance companies, which can end up paying well over $1,000 for laboratory studies that involve much higher overhead. “You’re not paying someone to be up a night monitoring you, you’re not having to pay for the rent and the electricity.” The portable monitors generally cost somewhere between $200 and $250 per test to operate, and are also preferred by most patients. Where undergoing a sleep study in a laboratory setting requires leaving home, sleeping in an unfamiliar room and bed in which professional sleep lab staff are observing you while you are hooked up to numerous wires and sensors, the portable monitors allow patients to remain in the comfort of their own bedrooms without strangers looking at them. They are relatively simple to operate and provide a much easier option for those who do not live close to a sleep laboratory.
Sleep physicians estimate that nine percent of the American public has moderate to serious sleep apnea, a condition that causes their throats to collapse and block their airways while they are sleeping. The brain reacts to the subsequent lack of oxygen by gasping for breath, awakening the body repeatedly throughout the night. The person with obstructive sleep apnea often is not aware that they are experiencing this, though it may happen hundreds of times per night. Most patients are diagnosed following observation of the gasping by their sleep partners or as a result of seeking diagnosis and treatment for overwhelming daytime sleepiness.
Though the new guidelines have been welcomed by the insurance industry, and patients may find the use of portable monitoring equipment more palatable, there are many in the sleep profession that are concerned about the possibility that certain diagnoses will not be made or that the monitors will not provide results that are accurate. Dr. Michael Thorpy is the director of the Sleep-Wake Disorders Center at Montefiore Medical Center in New York City. He says that in about twenty percent of patients that use the home units, the information that is gathered is not usable. He also says that those who are not suffering from more severe cases of obstructive sleep apnea may not be diagnosed with the use of the less sensitive equipment. He suggests that the insurance companies need to understand that there are clear limitations of using the portable units.
Despite these concerns, the new guidelines were assembled after reviewing data that has been gathered from research done over the past seventy years, and holy says, “For the average person they’re just as accurate as an in-lab study.” There is no doubt that the use of the at home units will likely allow more patients to be tested, thus meaning that more will be diagnosed and treated for the serious condition. Sleep apnea has been linked to a number of serious health conditions, including higher risk of cardiovascular disease, diabetes, high blood pressure and stroke. It is often caused by obesity. Sleep apnea and its resulting sleep deprivation have also been linked to a number of cognitive shortcomings as people have more difficulty with memory tasks and learning. Scientists estimate that roughly ninety percent of those who currently have sleep apnea have not yet been diagnosed.
Once a patient has been diagnosed with obstructive sleep apnea, there are a number of options available to them. Though sleep apnea has no cure, there are therapies that have proven to be very effective. The first line of defense against the condition is oriented around a patient’s overall health – if they smoke they are urged to stop, as smoking severely exacerbates the problem. The same is true of patients who are overweight or obese. Many patients are able to improve their symptoms simply by losing weight and beginning to exercise.
Beyond these lifestyle changes, the most commonly prescribed treatment for obstructive sleep apnea is the use of a continuous positive airway pressure device, or CPAP. CPAP machines are devices that provide a flow of air into the patient’s airway via a mask that is worn over their face as they sleep. Though many find it cumbersome or uncomfortable and it may take some getting used to, the machines have an immediate positive impact. For those who cannot tolerate the equipment, other options include the use of oral appliances that position their jaw in a way that prevents their airway from closing. Others submit to surgical procedures to remove obstructions.