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Prevalence of Sleep Apnea

More than half of the patients you see each day should be tested!




American Heart Association
American College of Cardiology
Heart Failure Society of America
All Recommend that:

• Sleep Apnea be listed as an identifiable cause of Heart Failure
• Recommended that all newly diagnosed patients be screened for Sleep Apnea
• Patients who are refractory to treatment for Heart Failure should be screened for Sleep Apnea

American Heart Association. Heart Disease and Stroke Statistics – 2005 Update. Dallas, TX. AHA 2005

Why we should be interested in diagnosing and treating sleep disorders?

Clinical Considerations

• Recognition of the high prevalence of sleep apnea in patients with cardiovascular disease (30-80%)¹
• 4% of women and 9% of men have clinically significant sleep disordered breathing²
• Proven benefits from sleep therapy are wide ranging and include decreasing blood pressure by 4-10mm Hg³
• Increasing the survival rates in heart failure patients by improving LV ejection fraction by 5-16%⁴
• Highly undiagnosed patient population of less than 10% (4 million out of 44 million)⁵
• Sleep apnea is an identifiable cause of hypertension according to the NIH⁶
• 100% of heart failure patients on CPAP therapy Improve their EF by 5-16% after just one month on compliant therapy⁷
• In patients with heart failure, OSA confers an increased risk of death⁸

Economic Considerations

• Hospitalization stay rates were higher (251nights vs. 90 nights) for patients with untreated sleep apnea.⁹
• Medical Costs of undiagnosed sleep apnea patients were double in the year prior to diagnosis ($2,720 vs. $1,384)¹⁰
• Patients utilized 23-50% more medical resources prior to apnea diagnosis¹¹

Benefits of Treatment

CPAP was first developed in 1980 and remains the gold standard still today for the treatment of obstructive sleep apnea. In the past decade, there have been numerous advances that have improved the convenience, comfort, and efficacy of CPAP devices. The development of oral devices and the improvement in surgical procedures have also come about and have been improved upon. Advances in portable monitoring have allowed highly specific diagnosis to be performed in the home or at a patient’s hospital bedside. In addition, most manufacturers now produce very small, quiet, highly effective CPAP devices that allow significantly better patient acceptance and compliance. CPAP devices have also become more sophisticated, including flow-limitation algorithms and measures of compliance and treatment efficacy. Of equal importance, nasal interfaces are now much smaller, more comfortable, come in a wider variety and they leak less. Compliance issues still exist, however with the increase in compliance programs and new mandates by CMS and the insurance industry, we hope to see improvement in patient outcomes and an increase in overall patient compliance.

 

References

1 (J. Hypertension, Circulation, Cardiology)
2 (T. Young NEJM 1993)
3 (Becker et al. Circulation 2003)
4 (Kaneko et al. N Engl J Med 2003)
5 (T. Young NEJM 1993)
6 (JNC 7)
7 (Bradley et al., NEJM 2005)
8 (Wang et al., JACC 2007)
9 (Kryger, et al., SLEEP 1997)
10 (Kapur, et al., SLEEP 1999)
11 (Smith, et al.., CHEST 2002)