Consumer Awareness of Sleep Apnea is First Step

In every issue of Home Health Products,we provide you with the product solutions you need for your clients. But what if a client needs a product to improve their overall health and wellbeing, but they do not know it? Many of the 18 million people who suffer from the effects of sleep apnea are undiagnosed.

Before clients can seek the CPAPs they need to treat their sleep apnea, they need to: 1. Recognize the warning signs and 2. Be tested.

The warning signs include sleepiness during the day, snoring, someone observing that breathing has stopped, morning headaches or dry mouth, high blood pressure or depression that doesn't respond to treatment. These signs indicate that an evaluation is needed.

But a recent study found that the usual practice of a single-night study for sleep apnea might not be enough.

In an analysis of more than 1,220 patients tested for the presence of obstructive sleep apnea, researchers found evidence that patients showed less night-to-night variability in their response to sleep testing in the home, when compared to the standard approach of testing patients in a sleep laboratory.

The analysis, published in the current issue of the peer-reviewed journal, Otolaryngology-Head and Neck Surgery, was supported by the Research Service and Health Services Research and Development Service of the Department of Veteran Affairs and was conducted under the supervision of the University of California, San Diego Institutional Review Board.

According to the National Sleep Foundation, more than 18 million Americans suffer from the effects of sleep apnea, including a growing number of significant health problems such as attention deficit, daytime drowsiness and memory impairment, neuromuscular disorders, psychiatric conditions such as depression and anxiety, as well as increased risk of hypertension, diabetes and cardiovascular disease.

As described in the paper, the night-to-night breathing variability found with patients tested for sleep apnea may be influenced by "daily activity level, medication usage, or other unknown or unappreciated environmental factors." Previous research has also demonstrated the presence of a "first night effect" experienced by patients sleeping in an unfamiliar sleep laboratory environment which influences the patient's usual sleeping patterns.

While patients experience varying levels of sleep disordered breathing from night to night, sleep laboratories normally test patients for only one night. In about 20 percent of the time, patients are only tested for a couple of hours, commonly referred to as split-night studies.

Because of this night-to-night variability, where a borderline single-night test result is obtained, a repeat study may be warranted for a patient suspected of having obstructive sleep apnea. The current study documents that variability in breathing patterns from night to night in studies conducted in the privacy of the patient's home is not significant and may be more reliable than studies conducted in a sleep laboratory setting.

"While making an accurate diagnosis is important and our understanding of the nightly variability has been advanced as a result of the current study, there remains a large number of Americans with undiagnosed sleep apnea," said the study's lead author, Carl Stepnowsky, PhD. "We need to continue to increase our capacity both for appropriately diagnosing and treating sleep apnea."

A recent study by Dr. Flemons of the University of Calgary showed long wait times for sleep apnea diagnostic testing in five different countries. Delayed diagnostic testing results in delayed treatment initialization, which only allows for the further progression of disease and the subsequent increased risk of morbidity and mortality.

Another recent paper by Dr. Ayappa of the NYU School of Medicine reaffirms the long waiting times (one or more months) for sleep laboratory availability and, therefore, the need for home sleep testing.

"This paper, supported by additional published research, demonstrates the importance of providing home sleep testing for the accurate diagnosis of obstructive sleep apnea," said Michael J. Thomas, president and CEO of Sleep Solutions Inc. "We are especially pleased that this important research was based on just a portion of the thousands of patients who have been successfully tested for up to three full nights at home using our NovaSom QSG diagnostic sleep system."

There is a repeated theme in many market segments of this industry: consumer awareness. We all need to play our part in adding to people's awareness of sleep apnea so that more people will seek testing and treatment. If so, these consumers will get the products that they need and live better lives as a result.

This article originally appeared in the January 2005 issue of HME Business.

About the Authors

Nikolay Voutchkov, PE, DEE, is senior vice president of Technical Services at Poseidon Resources Corp. in Stamford, Conn. He can be reached at 203-327-7740, ext. 126.

Jackson is the former managing editor of Home Health Products.

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