Urgent Need For Low-Cost In-Home Diagnostics For Obstructive Sleep ApneaTuesday, December 5, 2017
Today’s guest post comes from Christy Turer, MD, Assistant Professor of Pediatrics, Internal Medicine, and Clinical Sciences at University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA.
This week, I saw a 50 year-old female patient with obesity (BMI 44) who desperately needs screening and treatment for obstructive sleep apnea (OSA).
Over the past four years, her heart function (ejection fraction) has declined from >60% to now ~20% with significant pulmonary hypertension, almost certainly related to undiagnosed, untreated OSA based on multiple nightly witnessed apneas.
Although she now sleeps with oxygen, this does nothing for her hypopnea-related, sympathetic overdrive-mediated, cardiac dysfunction.
Without CPAP treatment, her life expectancy is two years or less.
Unfortunately, within the public health system for which I work (county system that offers free or discounted healthcare to poor residents in a metropolitan city, USA), the average wait time for a sleep study is 1-2 years.
To be fair, this patient has had a previous attempt at a sleep study in a sleep lab a couple of years ago. At that time, however, the study was inconclusive, because she could not fall asleep in the sleep lab’s unfamiliar environment.
It is frustrating not being able to help my patients with suspected sleep apnea, especially, when I know that help could be available.
It is high time we had a technological disruption that enables cheap, reliable, in-home OSA assessment for patients.
Christy Turer, MD
Dr Turer is a standing member of the US Food and Drug Administration’s Pediatric Advisory Committee, a consultant to the FDA’s Endocrinologic/Metabolic Drugs Advisory Committee, and Past-Chair of the Obesity Society’s Clinical Management of Obesity Section. She has authored numerous scientific articles and lectured widely on primary-care evaluation and management of overweight/obesity and related metabolic comorbidities across the lifespan. Her comments do not reflect the views of UTSW, FDA, or any of her funding sources.
Tuesday, December 5, 2017
From cross-post in Facebook:
Sleep MD here, having been IM for 10 years prior. Testing is not the main problem. I see a zillion patients who were home tested in the past, placed on a “set-it- and-forget-it” AutoPAP with no sleep follow up and it does not work for the majority of patients. They need education and follow up on sleep apnea and sleep issues. Practically every single patient who comes into my clinic says, “No one ever told me that!”. Also, patients with BMI of >40-50+ often have concurrent obesity hypoventilation syndrome which cannot be accurately diagnosed on a home test. They often need BIPAP which cannot be auto-titrated. They need proper care. There are very clear AASM guidelines on what is appropriate use of HST vs in-lab study.
Christy Boling Turer May I have your permission to post your comment on the obesity notes page? I’d put your name and full unchanged reply…let me know.
Radhika Sekhribreaden I would be honored. I am board certified in obesity medicine, sleep medicine and IM and always happen to answer *any* questions about sleep medicine!
Radhika Sekhribreaden http://jcsm.aasm.org/ViewAbstract.aspx?pid=30972
JCSM – Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. jcsm.aasm.org
Radhika Sekhribreaden Patients with obesity need to know that poor sleep quality and quantity is associated with increased insulin resistance and may hinder their weight loss attempts unless it is concurrently treated.