Diagnosing Sleep Apnea - Leave it to the Amateurs!

It seems that there is an epidemic of obstructive sleep apnea (OSA) out there.  Snoring, a harbinger of OSA, seems to have captured the national attention, at least judging by the ubiquitous ads I am subjected to hourly on the radio.  Gastroenterologists routinely inquire about the presence of OSA in our patients as this may increase the risks of sedation and anesthesia. 

Most patients with OSA are undiagnosed.  Many of them are not aware that the condition troubles them, but experts warn of potential long term consequences if the condition is not treated.  The diagnosis is classically made after an overnight sleep study when the patient is monitored.  I have equal confidence in the diagnostic skills of those who sleep in the same room as the individual at home.  For example, if a patient’s wife tells me that her husband regularly (and fortunately temporarily!) stops breathing during sleep, I think that the diagnosis has been securely made.  In these cases, I am unsure how an overnight sleep study would alter the treatment plan, but I suspect that most sleep physicians would still recommend it.

Why is everyone so tired?

The usual treatment is for the patient to don a clumsy and noisy helmet apparatus called CPAP while sleeping.  Many patients find this remedy to be worse than the disease and have eschewed this recommendation.   I expect that technological innovation will make progress on this front.

I offer readers an interesting side note on one of the warning signs of OSA – snoring.  I find that patients often regard snoring as if it were a moral failing.  For example, if I ask a patient if he snores, he may point to his wife in the exam room exclaiming, “you should hear how loud she snores!.   This scenario has repeated itself over the years and always amuses me.   Snoring isn’t a vice that needs to be minimized by pointing to a fellow sufferer.

Sleep is important and most of us don’t get enough of it.  Wouldn’t life be better if an afternoon siesta became a daily routine in our culture?