Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Sunday, January 24, 2010

Why Don't Sleep Doctors, Sleep Centers, Sleep Techs and DME's tell patients that CPAP fails most patients?

A Recent John Hopkins University study published in August 2009 in PloS Medicine has indicated that snoring with severe obstructive sleep apnea doubles the chance of premature deaths in men aged 40 to 70 years. PloS Medicine is a peer-reviewed open-access journal published by the Public Library of Science.

This is not new information but just another study showing the severe risks associated with untreated sleep apnea. Other facts are that patients with untreated sleep apnea have a six fold increase in motor vehicle accidents and they are more likely to die in their sleep that while exercising.

I see so many patients who are not being treated for sleep apnea because they hate CPAP or could not deal with problems associated with CPAP use. The Sleep Centers, Doctors , Sleep Techs and DME companies that fail to refer patients for alternative therapies must bear the brunt of responsibility. 60 % of patients abandon CPAP use but there is no concerted effort to refer them for oral appliances.

The real question is why aren't more patients referred for appliance therapy.

I think ignorance is the primary cause, many sleep professionals are unaware of the high success rates of oral appliances, and some just do not know much at all. There is a subgroup that has vested interests in CPAP prescriptions. The sleep centers are often own DME companies, Sometimes the doctor's wife or children own the DME company. I do not find this to be a problem as long as patients who do not tolerate CPAP are then referred for oral appliances or surgical intervention.

I have patients tell me that they are made to feel like it is their failure when they can't tolerate CPAP. They are not told the the majority of patients are CPAP intolerant and/or fail CPAP. CPAP is a excellent treatment for a significant number of patients with very high eficacy, unfortunately more patients fail with CPAP then succeed.

It is the makers or CPAP, Distributors and DME companies and all sleep professionals to honestly explain to patients that the majority of patients never learn to tolerate CPAP and to help them find alternative treatments.

Insurance companies are probably most at fault because they share a common interest with patients. Finding alternative treatments for patients who fail CPAP will save insurance companies enormous amounts of future medical expenses. Insurance companies are aware that oral appliances are more expensive than CPAP in the short run but pale compared to costs for treating heart attacks or strokes. Insurance companies should review their files and identify patients prescribed CPAP who do not order additional supplies. In all likely-hood these patients are not using CPAP and therefore are at a greatly increased risk not just of cardiovascular events but also faced increased risks related to diabetes, motor vehicle accidents, and other serious medical problems.

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posted by Dr Shapira at 8:48 AM