Date:
01/07/2008 02:34 PM HEALTHBEAT: Snoring could mean sleep apnea; Medicare
proposal might help catch more patients
By LAURAN NEERGAARD
AP Medical Writer
WASHINGTON (AP) _ Loud snoring doesn't just
annoy your spouse. It could signal dangerous sleep apnea,
yet millions go undiagnosed.
A government move may help change that: Medicare
is poised to allow at-home testing for sleep apnea —
letting people snooze in their own beds instead of spending
the night in a sleep laboratory.
It's a controversial proposal, but potentially
a far-reaching one. Some 18 million Americans are estimated
to suffer from sleep apnea, yet specialists think fewer than
half know it.
"It's been awkward and inconvenient and
expensive to get a sleep test, and now that should be improved,"
says Dr. Terence Davidson of the University of California,
San Diego, a longtime proponent of home-testing.
Today, Medicare pays for sleep apnea treatment
— called CPAP, a mask that blows air through the nose
while sleeping — only for seniors diagnosed in a sleep
lab. Last month, Medicare proposed covering those diagnosed
with cheaper home tests, too. The public may comment on the
proposal until next week; final approval is expected in March.
While sleep apnea is a problem for seniors,
it is most common in middle-aged men. But private insurers
now reluctant to cover home apnea testing are expected to
follow the government's lead, thus easing access for all ages.
Sleep apnea doesn't just deprive family members
of their own zzzz's. Sufferers actually quit breathing for
30 seconds or so at a time, as their throat muscles temporarily
collapse. They jerk awake to gasp in air, sometimes more than
15 times an hour. They're fatigued the next day because their
brains never got enough deep sleep.
Severe apnea increases the chance of a car
crash sevenfold. Research from UCSD suggests 1,400 deaths
each year are caused by drivers with sleep apnea.
Worse, sleep apnea stresses the body in ways
that also increase risk of high blood pressure, heart attack,
stroke and diabetes.
Not every apnea patient is a bad snorer, and
a low rumble may not be cause for concern. But sleep apnea's
trademark is bad snoring, the snorting, choking kind. Other
risk factors: Being overweight, having small airways, and
apnea in the family.
Yet patients don't remember the nightly breathing
struggle, and often don't see a doctor unless a family member
complains about snoring — or until daytime sleepiness
gets so bad they can't function.
Only then comes the test debate.
There are dozens of sleep disorders. A night
slumbering in a sleep lab, hooked to monitors that measure
both breathing and brain waves while health workers watch,
has long been the standard for telling who has sleep apnea
or another disorder.
But this lab-based polysomnography, or PSG,
can cost $1,500. And while access has improved, there are
swaths of the country where reaching a sleep lab can mean
a few hundred miles' drive.
For about $500, home tests use primarily breathing
monitors to detect only sleep apnea, not other disorders.
Hook it up at bedtime, and a doctor checks the recordings
later.
A home test can miss apnea, because it won't
signal if someone never fell into that deep REM sleep where
breathing is most likely to falter, says Dr. Thomas Gravelyn
of the Saint Joseph Mercy Hospital sleep center in Ann Arbor,
Mich., who opposes the Medicare change.
"You have this good feeling that everything
was taken care of, when in fact it wasn't," he says.
"It certainly is possible to diagnose
severe apnea at home," adds Dr. Joyce Walsleben, chief
of New York University's sleep center. "What if it isn't
severe? Are you willing to say it doesn't exist at all if
you get a negative study?"
Still, a Canadian study published last year
randomly assigned suspected apnea sufferers to either a sleep
lab or home testing, and found they worked equally well.
Last month, the American Academy of Sleep
Medicine, which represents sleep centers, changed its position
to say home tests can help certain high-risk patients —
but should be administered by sleep specialists.
Medicare's proposal wouldn't limit which doctors
offer home tests. The American Academy of Otolaryngology,
head-and-neck surgeons, requested the change.
In fact, Medicare concluded a sleep-lab test
isn't perfect, either — and thus proposed that all patients
get a 12-week trial of CPAP treatment. Only if their doctors
certify they're being helped would treatment continue.
That's important, because about half of apnea
patients prescribed CPAP struggle to use it, says Dr. Charles
Atwood of the University of Pittsburgh Medical Center, a home-test
proponent. What he calls tricks of the trade — trying
differently shaped masks, adjusting the air pressure, adding
a humidifier to moisten nostrils — early could keep
more of them in care.
Consider Raymond Miles, 57, diagnosed with
a sleep-lab study a few years ago. While he felt better with
CPAP treatment, Miles quit it in frustration when he couldn't
get help maintaining it.
Two weeks ago, nudged by his wife, Miles underwent
a home test with a different doctor to see if it's time to
try care again.
"There's a different level of comfort
being at home," Miles says of the testing.
———
EDITOR's NOTE — Lauran Neergaard covers
health and medical issues for The Associated Press in Washington.
To comment on the Medicare proposal: http://www.cms.hhs.gov/mcd/viewtrackingsheet.asp?from2=viewtrackingsheet.asp
&id204&
