Sleep Apnea — unreasonable testing

manwithcpapU.S. healthcare has gone crazy with testing for sleep apnea!   No wonder:  the standard test for the condition makes sleep specialists $1000 a pop.  Talk about a “hammer”, anyone that snores or is overweight is a “nail”.  People should be asking for 2 things before going down the testing road.

 

  1. A standard sleep apnea screening questionnaire.
  2. A night-time screening home oximetry test.

If  the questionnaire and the oximetry are called “low probability” then stop the testing.

Sleep apnea is real and the people that suffer from the condition do need treatment.   But, here’s the problem:  mild sleep apnea does not need treatment.  Yet, community sleep specialists have equated any sign of sleep apnea with the need for extensive testing and at least some type of treatment.

Well controlled scientific studies show that testing and treatment for sleep apnea are cost effective.  Indeed, that may be true, but community sleep specialists are not following the guidelines as in the large studies.  And, case-finding by community primary care is mostly based on the presence of snoring.  Once the person is sent to a specialist it seems to be implied that an in-center sleep test (polysomnography) is warranted.

Here are some disturbing facts:

  • 25% of the U.S. population snores
  • 25% of people who start CPAP treatment stop treatment
  • Pre-testing questionnaires are common but testing is done despite a low probability of the condition
  • Sleep specialists only consider the expensive in-center sleep test as adequate for their purposes (other outpatient home tests work well for many patients)
  • Surgery and dental prosthesis fail 50% of the time and are not recommended for first-line treatment.  Yet, people are often sent to surgeons and dentists without trying CPAP (the gold standard) or APAP.

 

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