The LEGACY study found that weight loss improved both symptoms and cardiac arrhythmias in persons with atrial fibrillation.
Medscape discusses the findings of the LEGACY trial here:
http://www.medscape.com/viewarticle/841515 (for registered users of Medscape)
Here is a link to the article's abstract:
http://content.onlinejacc.org/article.aspx?articleID=2196400
I wonder how much of the improvement in atrial fibrillation came from the treatment (by weight loss) of undiagnosed obstructive sleep apnea???
There is strong evidence for a relationship between OSA and atrial fibrillation. Control of obstructive sleep apnea through CPAP treatment approximately doubles the success rate of rhythm control in persons with atrial fibrillation.
Monday, March 23, 2015
Friday, March 08, 2013
Sunday, December 16, 2012
Link Between Sleep Disturbance and Suicide
Editor's note: Below is another guest blog post.
Here is a link to the actual journal article being discussed: http://www.ncbi.nlm.nih.gov/pubmed/21886352.
There has been a lot of research looking at the relationship between insomnia and depression. Insomnia does appear to be a risk factor for depression, but it is difficult in these population-based studies to definitively demonstrate a causal relationship. The fact that insomnia is one of the symptoms of depression makes it especially difficult. The article being discussed looks specifically at suicide.
Michael Rack, MD
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Here is a link to the actual journal article being discussed: http://www.ncbi.nlm.nih.gov/pubmed/21886352.
There has been a lot of research looking at the relationship between insomnia and depression. Insomnia does appear to be a risk factor for depression, but it is difficult in these population-based studies to definitively demonstrate a causal relationship. The fact that insomnia is one of the symptoms of depression makes it especially difficult. The article being discussed looks specifically at suicide.
Michael Rack, MD
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Lack
of good, solid sleep on a regular basis has been recognized by doctors as a
risk factor for increased health problems for many years. For example, presence
of untreated obstructive sleep apnea (OSA) greatly raises the risk of
cardiovascular disease, stroke and premature death. More recent studies have
established a link between insomnia and increased risk of suicide. This isn’t
completely surprising, given that almost everyone has experienced a sour mood
after a poor night of sleep. One can begin to imagine how it would feel for
this to go on and on for months or even years.
The
question of sleep quality and suicide is a difficult one to approach, and not
just because of the emotional nature of the topic. Many studies have found such
an association, but they were unclear about cause and effect, especially as
depression and/or anxiety were also often involved. It has therefore been
uncertain if poor sleep and suicide were, for example, two separate effects of
depression or anxiety, versus there being a direct link between lack of sleep
and taking one’s life. After all, depression and anxiety are risk factors for
both poor sleep and suicidal thoughts
and actions.
The
newest study does a better job of teasing out the separate variables involved
in sleep quality and suicide. The results suggest that even when depression and
anxiety are factored into the analysis, people who slept poorly were still more
likely to think about, plan, or actually make attempts at suicide. This was
possible because tens of thousands of people were considered in the study, and
this included many depressed or anxious people who were not bothered by poor sleep. Depressed and anxious people who
managed to sleep fairly well were much less likely to commit suicide than
similar folks who reported poor sleep.
The
study was conducted in Norway, where extremely detailed records are kept of
peoples’ health histories as well as all causes of death. Another aspect of the
study that gives it significance is that there was a “dose-response”
relationship – a term borrowed from tests of medications – between worse sleep
and greater likelihood of suicidal thoughts, plans or actions. People who
indicated they had poor sleep ‘almost every night’ had significantly more
suicidal thoughts and actions than those who said their sleep was poor ‘two or
three nights a week’ or ‘once a week of less.’
This
most recent study comes on top of many others in the past decade or more that
hinted at the same conclusion. While some of those studies were small or had
other weaknesses to them, the Norwegian study corrected for virtually all such
faults. The study was published in the peer-reviewed medical journal Sleep. It was accompanied by an
editorial by Dr. W. Vaughn McCall, a sleep expert at Wake Forest University
Health Sciences Center in Winston-Salem, NC. He noted that the cumulative
studies on this topic had been done with many different populations of people,
both old and young, and concluded bluntly, “The time has come to recognize
insomnia as a risk factor for suicide, and to include it in the list of potentially
modifiable risk factors.”
This
study and the ones preceding it have practical ramifications. Dr. McCall urged
doctors to ask more exploratory questions of those patients seeking sleep aids,
to determine if there are signs of depression or actual thoughts of suicide
that deserve treatment along with the insomnia complaint. As for the average
person, those suffering from insomnia should make all reasonable attempts to
sleep better, whether by getting more exercise during the day or by visiting
their doctors to discuss their sleep problems.
Sometimes
getting a better night’s sleep involves only simple behavioral changes, such as
not exercising or watching TV right before bedtime. In other cases, a
short-term course of medication, perhaps with some counseling sessions, may be
in order. The outcome of such interventions may go well beyond simply giving
someone a better night’s sleep, to actually having a life-saving effect.
SleepDisorders.com
is an informational portal helping to educate sleep disorder sufferers and
connect them to doctors in their area.
Tuesday, October 23, 2012
Sleep Apnea – NOT for Men Only!
Below is another guest blog post. One clarification I would like to make to the guest articleby Alex Smith is that the increased frequency of night-time urination seen with OSA is often due to increased urine production (for an explanation, see http://www.thoracicandsleep.com.au/latest-news/115-obstructive-sleep-apnoea-osa-and-urinating-at-night )
Michael Rack, MD
-----------------------------------------------------------------
Michael Rack, MD
-----------------------------------------------------------------
Doctors and patients alike are beginning to realize that
sleep apnea in women is more common than previously thought. Men remain
statistically more likely to develop obstructive sleep apnea (OSA), but instead
of a ten-to-one ratio of men to women, it’s now thought to be three- or
four-to-one. At the same time, women also remain more likely to have sleep
apnea misdiagnosed as something else, such as chronic fatigue syndrome,
depression or simple insomnia.
OSA occurs when the soft tissues of the throat and at the
back of the mouth become overly relaxed at night, to the point where one’s
airflow is blocked upon breathing in. This results in a few seconds of not
breathing, which may be evidenced by snoring or gasping for breath during one’s
sleep, followed by daytime sleepiness. Though women with OSA may have these signs, they seem to
appear more often in men. Women with sleep apnea may notice their mouths being
very dry in the morning. They may also begin to wake up more often during the
night with the need to urinate. This is not
due to any real increase in urine production, but because the partial waking
that often occurs in OSA allows a person to notice the state of their bladder
more than when they are sleeping soundly.
The risk for OSA increases as a woman ages and it is
sometimes said that menopause increases the risk for it. However, here again,
appearances may be deceiving, with menopause getting the blame for simple
changes in soft tissue tone that come with aging. Another risk factor for OSA
in women, just as in men, is being overweight or obese. This is simply due to
the increased thickness of throat tissues that begin to accumulate fat cells.
In some studies, as many as 80% of obese women screened for sleep apnea were found
to have the condition. It can also flare up due to the weight gain of
pregnancy. Drinking alcohol before bed time also increases the likelihood of
OSA, as does smoking.
Though women are still a bit less likely than men to have
OSA, it unfortunately appears that their risk of mortality from it is greater
than in men. The reason for this is not clear, but it seems to be especially
true in regards to heart and circulation problems, i.e., decreased cardiovascular health. It was recently reported
that OSA increases the risk of developing so-called ‘soft’ plaques in
atherosclerosis (hardening of the arteries), which are more likely to come
loose from blood vessel walls and form an embolus, blockage of an artery or
vein.
If a woman has sleep apnea, especially if she is overweight
or obese, she has a greater risk during pregnancy of developing the
life-threatening condition called pre-eclampsia, or of needing to deliver her
baby by caesarian section. Since pregnancy itself somewhat raises the risk of
OSA, this seems a real life case of double jeopardy! A pregnant woman may also
be more apt to attribute daytime sleepiness or fatigue to simply carrying a
baby, rather than to other possible causes.
For all these reasons, it is especially important for women
to know that they, too, are at risk for sleep apnea. If there are signs of dry
mouth, excessive daytime sleepiness, or any reports from her partner that she
is snoring, a woman should not hesitate to ask her doctor if she might have
sleep apnea. It is diagnosed definitively by performing an overnight sleep
study at the hospital. Because OSA can have serious health repercussions if
left untreated, insurance companies typically cover both the sleep study and the
therapy the condition requires if found. Women and men alike thus have nothing
to lose with a sleep
study, and may also gain a much better night’s sleep for their efforts.
Guest
article by Alex Smith of SleepDisorders.com.
Tuesday, October 02, 2012
Oral Appliances or CPAP, Which is Better?
The following is a guest blog post, see below this article for my thought on the issue:
Devices that provide CPAP, or continuous positive airway pressure, are often considered the “gold standard” of treatment for obstructive sleep apnea. After a sleep study is conducted and sleep apnea is diagnosed, a sleep specialist will typically prescribe CPAP machines and masks as the first line of treatment. Though the sleep disorder solution may be a blessing to many, others may find the device loud, restrictive and ineffective in getting them a better night’s rest. For patients who do not tolerate CPAP therapy, the American Academy of Sleep Medicine (AASM) has offered its recommendation for alternatives in the form of oral appliances.
In an issue of Sleep, researchers at the AASM released updated instructions for the treatment of obstructive sleep apnea with CPAP alternatives in an article entitled, “Practice Parameters for the Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliances.” Since the publication of these guidelines in 2006, patients diagnosed with mild to moderate sleep apnea have been able to take advantage of alternative devices. Physicians will prescribe the oral appliances to those who have already responded poorly to CPAP or to those who simply prefer another method. However, the AASM still advocates CPAP as the best form of treatment for patients with severe sleep apnea.
According to the AASM’s guidelines, the first step to treating sleep apnea of any severity is to have the sleep disorder diagnosed by a physician with ample experience in Sleep Medicine, particularly with sleep-disordered breathing. You can find certified sleep professionals in your area by searching local or online listings for sleep centers. To find a sleep dentist trained in oral appliances, experts such as Ira Shapira, DDS recommend that you find a sleep specialist that is a Diplomate of the Academy of Dental Sleep Medicine (ADSM).
If you have ever had to wear a mouth guard or an orthodontic retainer at night, you won’t have too much trouble adapting to an oral appliance for sleep apnea. The devices are designed to prevent the airway from collapsing while you sleep. This is most often achieved by moving your lower jaw, jaw muscles, uvula, soft palate, tongue or a combination of several of these parts.
The most common type of oral appliance is a mandibular repositioning device, which uses the upper jaw as an anchor to bring the lower jaw forward. In this position the walls of the pharynx and the tongue are also corrected. There are other oral appliances for sleep apnea available too, such as the tongue retaining device, which uses a suction mechanism to keep the tongue from falling backward and blocking the throat while you lie down.
In general, oral appliances have a higher compliance rate than CPAP in treating obstructive sleep apnea. Less than half of patients that are put on a CPAP treatment plan are actually able to continue the use of their machines and masks as recommended. And even these patients sometimes prefer oral appliances over CPAP because the oral devices are supposedly easier to use during travel and feel less distracting in shared bedrooms. Some oral devices, such as the Thornton Adjustable Positioner (TAP), have volume knobs that allow the patient to be more in control of sleep apnea treatment. Others, such as the Somnomed appliance, feature a straw through which you can drink water at night. In the end, the specific brand of oral appliance you use is not as important as keeping the upper airway unobstructed.
This is a guest blog post:
Sleepdisorders.com is designed to link sleep disorder sufferers to local sleep doctors and sleep centers. In addition to our directory of sleep doctors, you can find informational articles related to your unique sleep disorder.
_________________________
My thoughts: Oral appliances are a reasonable treatment option for mild to moderate OSA. CPAP remains the gold standard, especially for more severe forms of OSA. Oral appliances can be difficult to tolerate for some patients. In order to have success with an oral appliance, the involvement of a well-trained dental sleep specialist, working with a board-certified sleep doctor, is necessary. I do NOT recommend mail-order dental appliances.
Devices that provide CPAP, or continuous positive airway pressure, are often considered the “gold standard” of treatment for obstructive sleep apnea. After a sleep study is conducted and sleep apnea is diagnosed, a sleep specialist will typically prescribe CPAP machines and masks as the first line of treatment. Though the sleep disorder solution may be a blessing to many, others may find the device loud, restrictive and ineffective in getting them a better night’s rest. For patients who do not tolerate CPAP therapy, the American Academy of Sleep Medicine (AASM) has offered its recommendation for alternatives in the form of oral appliances.
In an issue of Sleep, researchers at the AASM released updated instructions for the treatment of obstructive sleep apnea with CPAP alternatives in an article entitled, “Practice Parameters for the Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliances.” Since the publication of these guidelines in 2006, patients diagnosed with mild to moderate sleep apnea have been able to take advantage of alternative devices. Physicians will prescribe the oral appliances to those who have already responded poorly to CPAP or to those who simply prefer another method. However, the AASM still advocates CPAP as the best form of treatment for patients with severe sleep apnea.
According to the AASM’s guidelines, the first step to treating sleep apnea of any severity is to have the sleep disorder diagnosed by a physician with ample experience in Sleep Medicine, particularly with sleep-disordered breathing. You can find certified sleep professionals in your area by searching local or online listings for sleep centers. To find a sleep dentist trained in oral appliances, experts such as Ira Shapira, DDS recommend that you find a sleep specialist that is a Diplomate of the Academy of Dental Sleep Medicine (ADSM).
If you have ever had to wear a mouth guard or an orthodontic retainer at night, you won’t have too much trouble adapting to an oral appliance for sleep apnea. The devices are designed to prevent the airway from collapsing while you sleep. This is most often achieved by moving your lower jaw, jaw muscles, uvula, soft palate, tongue or a combination of several of these parts.
The most common type of oral appliance is a mandibular repositioning device, which uses the upper jaw as an anchor to bring the lower jaw forward. In this position the walls of the pharynx and the tongue are also corrected. There are other oral appliances for sleep apnea available too, such as the tongue retaining device, which uses a suction mechanism to keep the tongue from falling backward and blocking the throat while you lie down.
In general, oral appliances have a higher compliance rate than CPAP in treating obstructive sleep apnea. Less than half of patients that are put on a CPAP treatment plan are actually able to continue the use of their machines and masks as recommended. And even these patients sometimes prefer oral appliances over CPAP because the oral devices are supposedly easier to use during travel and feel less distracting in shared bedrooms. Some oral devices, such as the Thornton Adjustable Positioner (TAP), have volume knobs that allow the patient to be more in control of sleep apnea treatment. Others, such as the Somnomed appliance, feature a straw through which you can drink water at night. In the end, the specific brand of oral appliance you use is not as important as keeping the upper airway unobstructed.
This is a guest blog post:
Sleepdisorders.com is designed to link sleep disorder sufferers to local sleep doctors and sleep centers. In addition to our directory of sleep doctors, you can find informational articles related to your unique sleep disorder.
_________________________
My thoughts: Oral appliances are a reasonable treatment option for mild to moderate OSA. CPAP remains the gold standard, especially for more severe forms of OSA. Oral appliances can be difficult to tolerate for some patients. In order to have success with an oral appliance, the involvement of a well-trained dental sleep specialist, working with a board-certified sleep doctor, is necessary. I do NOT recommend mail-order dental appliances.
Friday, September 14, 2012
Study Links Sleep Apnea to Increased Cancer Risk
A recent study, presented at the European Respiratory Society’s Annual Congress in Vienna, suggests that sleep apnea is linked to an increased risk of developing and dying from cancer. First, an overview of this condition: sleep apnea is a condition in which sleeping individuals experience abnormal pauses while breathing and the frequency of their breathing is abnormally low. Associating sleep apnea, an unpleasant sleeping condition, to an increased risk of developing cancer, not to mention dying from cancer, is surely the stuff of nightmares.
At the ERS Annual Congress experts presented two studies that provided substantial evidence in drawing an association between sleep apnea and cancer. The first study consisted of 5,600 patients from a total of seven sleep study facilities in Spain. In the study these medical experts utilized a hypoxaemia (which is the deficiency of oxygen in arterial blood) index in order to measure how severe sleep apnea was in each of the patients. The hypoxaemia index functions to record how long patients have had low oxygen levels (less than 90 percent oxygen saturation) in their blood while sleeping. Medical scientists discovered that individuals who had low oxygen levels in their blood during 14 percent of their sleeping, for instance 14 percent of an eight hour sleeping period, were 50 percent more likely of developing and dying from cancer. Of course, the patients who did not suffer from sleep apnea were not subject to these unfortunate odds. These medical experts also found a correlation between the sex of the patient and the likelihood of developing cancer. Male patients and young patients, in general, with sleep apnea are significantly more susceptible to developing life threatening cancer due to low levels of oxygen in arterial blood. Similar to the first study, the second study produced similar results. The evidence produced by the second study suggested that individuals with sleep apnea are more likely to develop cancer than those without the sleeping condition; the study suggested that there was a high prevalence of cancer in those with sleep apnea.
Now, the current focus of the study is to figure out the role of CPAP devices in the link between sleep apnea and cancer. CPAP (continuous positive airway pressure) treatment utilizes air pressure to keep a person’s airways open, making it an ideal method in treating patients with sleep apnea. CPAP treatment is often described as unpleasant since a patient must wear the mask over their nose and mouth while sleeping. The mask connects to a machine via tube which provides the patient with mild pressure air flow. Since CPAP uses air pressure to keep airways open, then patients ideally should not suffer from oxygen deficiency in their arterial blood. If there is no sign of oxygen deficiency in the patients’ arterial blood while they are sleeping, then the risk of developing life threatening cancer should be significantly reduced, if not avoided completely. CPAP treatment can be considered the light at the end of the tunnel for patients with sleep apnea.
This is a guest blog post:
Sleepdisorders.com is designed to link sleep disorder sufferers to local sleep doctors and sleep centers. In addition to our directory of sleep doctors, you can find informational articles related to your unique sleep disorder.
Thursday, May 24, 2012
Wednesday, May 23, 2012
EKG during sleep study
http://rebeldoctor.blogspot.com/2012/05/eng-during-sleep-study.html
Mobitz type 2 vs blocked PAC? I think it's Mobitz II, what do you think? (I gave this to the IT chief at Reggie White Medical Enterprises with poor instructions about which of my blogs to post it on, that's how it ended up on my old blog).
Mobitz type 2 vs blocked PAC? I think it's Mobitz II, what do you think? (I gave this to the IT chief at Reggie White Medical Enterprises with poor instructions about which of my blogs to post it on, that's how it ended up on my old blog).
Saturday, March 03, 2012
Do Sleeping Pills Kill?
A recent study published in BMJ Open found that the prescription of sleeping pills (hypnotics) was associated with a greater than threefold increase in the risk of death. The abstract and full article are available (free) here:
http://bmjopen.bmj.com/content/2/1/e000850.full
There are a number of problems with this study, as mentioned by Dr. Nancy Collop, President of the American Academy of Sleep Medicine:
"Although the study found that the use of hypnotic medication, or sleeping pills, was associated with an increased risk of mortality, a cause-and-effect relationship could not be established because the study only analyzed an insurance database... it was impossible for them to control for psychiatric conditions and anxiety, which is an area of significant concern to this study population..." http://www.medscape.com/viewarticle/759336?src=mpnews&spon=17
The major problem that I have with the study is that, as I far as I can see looking at the full article, the presence of insomnia was not controlled for (most of the comparison group did not have insomnia). Insomnia itself is associated with increased mortality (in some but not all studies) and morbidity (illness). To further illustrate why this is a problem, consider a hypothetical study in which the use of insulin was associated with an increased death rate. It is well known that dibetes itself increases the risk of death. If the comparison group in this hypothetical study did not have diabetes, I don't think much if anything could be learned from the study.
This new sleeping pill study doesn't add much new information to the field of sleep medicine, although it does add to the literature suggesting that insomnia is a serious problem. I did find this earlier editorial by Dr. Kripke (primary author of the current study) which sums up the problem with this current study:
"Numerous previous studies have shown an association of hypnotic use to mortality, which can become confounded with insomnia. Was mortality controlled for hypnotic usage in examining the association with insomnia?" http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079930/?tool=pubmed
To fully apply to the current study, that last statement can be changed to: Was mortality controlled for insomnia in examining the association with hypnotic usage?
------------------------------------------------------------------------------------------
Edit: The association between insomnia and death is a complex issue. It is clearly associated with illness/morbidity. This abstract sums up the issues: http://www.ncbi.nlm.nih.gov/pubmed/15600216
Some studies have found that while a subjective complaint of insomnia is not associated with an increased risk of death, short sleep time is.
http://bmjopen.bmj.com/content/2/1/e000850.full
There are a number of problems with this study, as mentioned by Dr. Nancy Collop, President of the American Academy of Sleep Medicine:
"Although the study found that the use of hypnotic medication, or sleeping pills, was associated with an increased risk of mortality, a cause-and-effect relationship could not be established because the study only analyzed an insurance database... it was impossible for them to control for psychiatric conditions and anxiety, which is an area of significant concern to this study population..." http://www.medscape.com/viewarticle/759336?src=mpnews&spon=17
The major problem that I have with the study is that, as I far as I can see looking at the full article, the presence of insomnia was not controlled for (most of the comparison group did not have insomnia). Insomnia itself is associated with increased mortality (in some but not all studies) and morbidity (illness). To further illustrate why this is a problem, consider a hypothetical study in which the use of insulin was associated with an increased death rate. It is well known that dibetes itself increases the risk of death. If the comparison group in this hypothetical study did not have diabetes, I don't think much if anything could be learned from the study.
This new sleeping pill study doesn't add much new information to the field of sleep medicine, although it does add to the literature suggesting that insomnia is a serious problem. I did find this earlier editorial by Dr. Kripke (primary author of the current study) which sums up the problem with this current study:
"Numerous previous studies have shown an association of hypnotic use to mortality, which can become confounded with insomnia. Was mortality controlled for hypnotic usage in examining the association with insomnia?" http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079930/?tool=pubmed
To fully apply to the current study, that last statement can be changed to: Was mortality controlled for insomnia in examining the association with hypnotic usage?
------------------------------------------------------------------------------------------
Edit: The association between insomnia and death is a complex issue. It is clearly associated with illness/morbidity. This abstract sums up the issues: http://www.ncbi.nlm.nih.gov/pubmed/15600216
Some studies have found that while a subjective complaint of insomnia is not associated with an increased risk of death, short sleep time is.
Wednesday, February 29, 2012
CDC Issues Warning About Nasal Washes
Nasal rinses can be very helpful for allergies, but can also be deadly:
http://denver.cbslocal.com/2012/02/28/cdc-issues-warning-about-nasal-washes/
" It’s because of a brain-eating amoeba called Naegleria fowleri" that can be present in tap water.
Many patients with sleep apnea use nasal rinses.... these are safe as long as boiled or distilled water are used. Similarly, tap water should not be used in CPAP humidifiers (distilled water is recommended).
http://denver.cbslocal.com/2012/02/28/cdc-issues-warning-about-nasal-washes/
" It’s because of a brain-eating amoeba called Naegleria fowleri" that can be present in tap water.
Many patients with sleep apnea use nasal rinses.... these are safe as long as boiled or distilled water are used. Similarly, tap water should not be used in CPAP humidifiers (distilled water is recommended).
Monday, February 27, 2012
Saturday, February 25, 2012
Heavy NFL players are at increased risk of Death
"The heaviest athletes are more than twice as likely to die before their 50th birthday than their teammates, according to a Scripps Howard News Service study of 3,850 professional-football players who have died in the last century."
http://www.sleepdt.com/heavy-nfl-players-twice-as-likely-to-die-before-50/
Many of these athletes likely had untreated or inadequately treated obstructive sleep apnea (OSA). The heavier NFL players tend to have large necks. Increased neck size (greater than 16 inches in men) is a risk factor for OSA, whether the increased neck size is due to fat or muscle. Obstructive sleep apnea increases the risk of various types of heart disease, including coronary artery disease, heart attack, and congestive heart failure.
An earlier 1994 study found that "offensive and defensive linemen had a 52 percent greater risk of dying from heart disease than the general population."
http://www.sleepdt.com/heavy-nfl-players-twice-as-likely-to-die-before-50/
Many of these athletes likely had untreated or inadequately treated obstructive sleep apnea (OSA). The heavier NFL players tend to have large necks. Increased neck size (greater than 16 inches in men) is a risk factor for OSA, whether the increased neck size is due to fat or muscle. Obstructive sleep apnea increases the risk of various types of heart disease, including coronary artery disease, heart attack, and congestive heart failure.
An earlier 1994 study found that "offensive and defensive linemen had a 52 percent greater risk of dying from heart disease than the general population."
Sleep Disorders are High in the South
A recent study found that "Oklahoma, Arkansas, Mississippi, Alabama and West Virginia had the highest rates of sleep disturbance and daytime fatigue"
I suspect that the high rate of sleep disturbance and fatigue in the south is due to obesity, a major risk factor for obstructive sleep apnea
Read more: http://www.foxnews.com/health/2012/02/24/southerners-sleepiest-in-us-study-says/#ixzz1nOmzb4lX
I will try to post a link to the actual research study later. As a southern sleep doctor (currently licensed in Mississippi and Alabama, formerly licensed in West Virginia), this topic is of concern to me.
I suspect that the high rate of sleep disturbance and fatigue in the south is due to obesity, a major risk factor for obstructive sleep apnea
Read more: http://www.foxnews.com/health/2012/02/24/southerners-sleepiest-in-us-study-says/#ixzz1nOmzb4lX
I will try to post a link to the actual research study later. As a southern sleep doctor (currently licensed in Mississippi and Alabama, formerly licensed in West Virginia), this topic is of concern to me.
Sunday, October 02, 2011
Compensation for Sleep Physicians
An experienced sleep technician recently asked me about compensation for sleep physician services at a sleep disorders center (IDTF) he is starting. Below is what I told him (disclaimer: this is based on my experiences over the last several years talking to numerous sleep professionals, and not on my own salary/compensation) -
1. There are 2 basic options for compensating the sleep physician for interpreting sleep studies. One is for the physician to bill for the professional component (-26) of the study, and the IDTF for the technical component (-TC). The other option is for the IDTF to bill for the studies on a global basis and pay the physician a fee for each interpretation. This fee typically ranges from $75 to $175 ($100-125 is average).
Although I am unsure if you can legally take it into account, the physician is going to probably expect to receive somewhere in the higher range if he is generating many of the referrals to the sleep center or providing outpt follow up to the patients. In this case, I would recommend letting the physician just bill for the professional component.
2. Medical director fees: Although some sleep centers try to bundle this in with interpretations, it is best from a legal standpoint to pay a separate fee for medical director duties (such as supervision of technicians, developing policies and procedures, administration, etc). There are 2 basic options. First, the medical director can keep a log of his administrative hours and be compensated on an hourly basis (typically $100-$150 per hour). The other option is to pay the medical director a fixed monthly fee- this is usually based on number of beds. $500-1000 for a 4 bed lab and $750-$1500 for a 6 bed lab are typical salaries.
One of the reasons that I don't recommend bundling sleep study interpretation fees with medical director fees is that it makes things "messy" if a 2nd sleep physician (other than the medical director) starts interpreting studies.
There are a lot of legal pitfalls in setting physician compensation, and I recommend consulting with an experienced healthcare attorney familiar with both federal regulations and the laws of your state.
I welcome reader comments regarding this subject
1. There are 2 basic options for compensating the sleep physician for interpreting sleep studies. One is for the physician to bill for the professional component (-26) of the study, and the IDTF for the technical component (-TC). The other option is for the IDTF to bill for the studies on a global basis and pay the physician a fee for each interpretation. This fee typically ranges from $75 to $175 ($100-125 is average).
Although I am unsure if you can legally take it into account, the physician is going to probably expect to receive somewhere in the higher range if he is generating many of the referrals to the sleep center or providing outpt follow up to the patients. In this case, I would recommend letting the physician just bill for the professional component.
2. Medical director fees: Although some sleep centers try to bundle this in with interpretations, it is best from a legal standpoint to pay a separate fee for medical director duties (such as supervision of technicians, developing policies and procedures, administration, etc). There are 2 basic options. First, the medical director can keep a log of his administrative hours and be compensated on an hourly basis (typically $100-$150 per hour). The other option is to pay the medical director a fixed monthly fee- this is usually based on number of beds. $500-1000 for a 4 bed lab and $750-$1500 for a 6 bed lab are typical salaries.
One of the reasons that I don't recommend bundling sleep study interpretation fees with medical director fees is that it makes things "messy" if a 2nd sleep physician (other than the medical director) starts interpreting studies.
There are a lot of legal pitfalls in setting physician compensation, and I recommend consulting with an experienced healthcare attorney familiar with both federal regulations and the laws of your state.
I welcome reader comments regarding this subject
Monday, March 07, 2011
Napping in the NBA
http://www.nytimes.com/2011/03/07/sports/basketball/07naps.html?_r=1&src=me&ref=sports
Some N.B.A. teams have received an education in the art of napping from Dr. Charles Czeisler, the director of the Division of Sleep Medicine at Harvard Medical School.
Czeisler said that players who got nine hours of sleep were more likely to react quicker, remember plays better and generally maintain their health more consistently.
---
still working on this
Some N.B.A. teams have received an education in the art of napping from Dr. Charles Czeisler, the director of the Division of Sleep Medicine at Harvard Medical School.
Czeisler said that players who got nine hours of sleep were more likely to react quicker, remember plays better and generally maintain their health more consistently.
---
still working on this
Tuesday, November 16, 2010
Reggie White Sleep Disorder Centers
The above is from the open h0use of the Tupelo branch of Reggie White Sleep Disorder Centers
Monday, November 01, 2010
How to Find a Medical Director for your Sleep Lab
I was recently contacted by a non-physician regarding how to find a medical director for a sleep lab she is opening. This sleep lab is not in my state (Mississippi). Here is my answer to her:
You can try advertising- either on the American Academy of Sleep Medicine Job Board, or in one of the sleep journals (either "Sleep" or "The Journal of Clincal Sleep Medicine"). You can also post the position at the Annual Sleep Meeting.
Another option is calling sleep physicians in your state (medical directors of existing sleep labs) and asking them if they are interested in being medical director of your sleep lab.
You can try advertising- either on the American Academy of Sleep Medicine Job Board, or in one of the sleep journals (either "Sleep" or "The Journal of Clincal Sleep Medicine"). You can also post the position at the Annual Sleep Meeting.
Another option is calling sleep physicians in your state (medical directors of existing sleep labs) and asking them if they are interested in being medical director of your sleep lab.
Sunday, June 27, 2010
Medicare qualifications for a Sleep Technician
Sleep studies performed on patients with medicare at an IDTF must be done by appropriately certified technicians. Below is the regulation (copied from an old reader comment):
CMS document 410.33 (2)(c) states "Nonphysician personnel. Any non-physician personnel used by the IDTF to perform tests must demonstrate the basic qualifications to perform the tests in question and have training and proficiency as evidenced by licensure or certification by the appropiate State health or education department. In the absence of a State licensing board, the technician must be certified by an appropiate national credentialing body. The IDTF must maintain documentation available for review that these requirements are met."
In most states there is no state licensure for sleep technicians.
It is fairly well accepted that the RPSGT and RRT credentials meet CMS requirements. It is unclear if RN (or LPN) is acceptable. The CPSGT credential is probably not sufficient, but I have not seen this officially.
If any readers have any clarification on this regulation, I would appreciate a comment.
Please note, this regulation applies only to IDTF's, not to hospital-associated sleep labs or to sleep labs organized as an extentsion to a physician practice.
CMS document 410.33 (2)(c) states "Nonphysician personnel. Any non-physician personnel used by the IDTF to perform tests must demonstrate the basic qualifications to perform the tests in question and have training and proficiency as evidenced by licensure or certification by the appropiate State health or education department. In the absence of a State licensing board, the technician must be certified by an appropiate national credentialing body. The IDTF must maintain documentation available for review that these requirements are met."
In most states there is no state licensure for sleep technicians.
It is fairly well accepted that the RPSGT and RRT credentials meet CMS requirements. It is unclear if RN (or LPN) is acceptable. The CPSGT credential is probably not sufficient, but I have not seen this officially.
If any readers have any clarification on this regulation, I would appreciate a comment.
Please note, this regulation applies only to IDTF's, not to hospital-associated sleep labs or to sleep labs organized as an extentsion to a physician practice.
Billing for Sleep Studies
I recently received an email asking about billing globally for sleep studies vs billing the professional and technical components separately. I came across this reference today:
http://www.arkmedicare.com/provider/viewarticle.aspx?articleid=8365
CPT 95805: Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness.
CPT 95810: Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist.
CPT 95811: Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist.
If a provider bills for the codes listed above without modifiers, the technical AND professional components are included in payment. If the professional component was not provided by a facility, the facility should bill the code using the TC modifier and the interpreting physician may bill with the -26 modifier. If the facility employs a provider who performs the professional component, then the facility may bill for the global code (without a modifier or the code with the -26 AND -TC modifiers).
http://www.arkmedicare.com/provider/viewarticle.aspx?articleid=8365
CPT 95805: Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness.
CPT 95810: Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist.
CPT 95811: Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist.
If a provider bills for the codes listed above without modifiers, the technical AND professional components are included in payment. If the professional component was not provided by a facility, the facility should bill the code using the TC modifier and the interpreting physician may bill with the -26 modifier. If the facility employs a provider who performs the professional component, then the facility may bill for the global code (without a modifier or the code with the -26 AND -TC modifiers).
prn MSLT's
A doctor asked on the AASM message board about prn (as needed) MSLT's. In his sleep medicine group, doctors sometimes order a nocturnal polysomnogram to evaluate for OSA, with instructions to the technicians to perform an MSLT if OSA is not found.
Should the practice of "prn" MSLT be abandoned? Is it a bad idea?
Here is my answer to the the doctor's question?
yes and yes.
If you think someone has narcolepsy/idiopathic hypersomnia it is reasonable to order a psg/MSLT with instructions that the MSLT be canceled if OSA is present (with the sleep physician being avaliable in the am to review the psg in borderline cases).
I think it is unreasonable and puts too much responsibility on the techs to have them decide whether an MSLT is neeed on large numbers of patients being evaluated for OSA.
Should the practice of "prn" MSLT be abandoned? Is it a bad idea?
Here is my answer to the the doctor's question?
yes and yes.
If you think someone has narcolepsy/idiopathic hypersomnia it is reasonable to order a psg/MSLT with instructions that the MSLT be canceled if OSA is present (with the sleep physician being avaliable in the am to review the psg in borderline cases).
I think it is unreasonable and puts too much responsibility on the techs to have them decide whether an MSLT is neeed on large numbers of patients being evaluated for OSA.
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