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).
Showing posts with label obstructive sleep apnea. Show all posts
Showing posts with label obstructive sleep apnea. Show all posts
Wednesday, February 29, 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, June 27, 2010
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.
Saturday, April 10, 2010
Sleeping Pills and Obstructive sleep apnea
This question was recently posted on Medscape's Physician connect:
I am treating a man who has sleep apnea and uses CPAP. He is on Trileptal and Lamictal. Recent problems with insomnia has made me suggest Sonata. Are there any concerns about this? Contraindications?
This is my answer (which also includes a response to a few of the comments posted on Physician Connect):
If a person is on an effective cpap pressure, the adverse effects of hypnotics should be no different than in someone without osa. I have treated thousands of patients with osa; some of them require ambien/lunesta/Sonata. I occasionally use benzodiazepines, especially restoril. There have been several studies showing that moderate doses of alcohol do not effect cpap requirements (not that I recommend alcohol). I do agree with having the patient check with the sleep clinic, however. What the patient is calling "insomnia" may be a sign of problems with cpap and should be addressed by his sleep physician.
I am treating a man who has sleep apnea and uses CPAP. He is on Trileptal and Lamictal. Recent problems with insomnia has made me suggest Sonata. Are there any concerns about this? Contraindications?
This is my answer (which also includes a response to a few of the comments posted on Physician Connect):
If a person is on an effective cpap pressure, the adverse effects of hypnotics should be no different than in someone without osa. I have treated thousands of patients with osa; some of them require ambien/lunesta/Sonata. I occasionally use benzodiazepines, especially restoril. There have been several studies showing that moderate doses of alcohol do not effect cpap requirements (not that I recommend alcohol). I do agree with having the patient check with the sleep clinic, however. What the patient is calling "insomnia" may be a sign of problems with cpap and should be addressed by his sleep physician.
Monday, February 08, 2010
Man Dies during Sleep Study
(from the Atlanta Journal-Constitution, via Drudge) A 25 year old man recently died during a sleep study at Emory:
Harris, a medical assistant, entered the Emory sleep center on Jan. 22, said his mother....... By the next morning he was dead.
Emory said in a statement that he died of sudden cardiac arrest....
The article doesn't give many details and doesn't specify whether Mr. Harris was having a diagnostic study or a CPAP titration study.
Usually the most dangerous part of a sleep study is the drive to the sleep center.
Harris, a medical assistant, entered the Emory sleep center on Jan. 22, said his mother....... By the next morning he was dead.
Emory said in a statement that he died of sudden cardiac arrest....
The article doesn't give many details and doesn't specify whether Mr. Harris was having a diagnostic study or a CPAP titration study.
Usually the most dangerous part of a sleep study is the drive to the sleep center.
Tuesday, February 02, 2010
Sleep Apnea in the Wall Street Journal
The Wall Street Journal has an article today giving a good overview of obstructive sleep apnea:
http://online.wsj.com/article/SB10001424052748704107204575039101390202576.html?mod=WSJ_hp_editorsPicks
http://online.wsj.com/article/SB10001424052748704107204575039101390202576.html?mod=WSJ_hp_editorsPicks
Sunday, October 11, 2009
OSA, Sleep Deprivation, and Alcohol
Once a person has one sleep problem, they are less able to cope with another one. For example, persons with obstructive sleep apnea are less able to cope with the demands of shift work.
A. Vakulin and colleagues pubished "Effects of Alcohol and Sleep Restriction on Simulated Driving Performance in Untreated Patients With Obstructive Sleep Apnea" in this months issue of Annals of Internal Medicine. This study compared patients with untreated OSA and matched controls on a driving simulator. The study found that "Patients with OSA are more vulnerable than healthy persons to the effects of alcohol consumption and sleep restriction on various driving performance variables. "
A. Vakulin and colleagues pubished "Effects of Alcohol and Sleep Restriction on Simulated Driving Performance in Untreated Patients With Obstructive Sleep Apnea" in this months issue of Annals of Internal Medicine. This study compared patients with untreated OSA and matched controls on a driving simulator. The study found that "Patients with OSA are more vulnerable than healthy persons to the effects of alcohol consumption and sleep restriction on various driving performance variables. "
Saturday, July 25, 2009
Sleep Disorders Linked to Aviation Accidents
Sleep disorders, especially obstructive sleep apnea, are common among truck drivers. USAToday reports that the National Transportation Safety Board is investigating fatigue as a cause of accidents in the aviation industry:
While efforts to reduce fatigue in aviation have focused on pilots' schedules, federal accident investigators say pilots and other vehicle operators also need to be screened for sleep disorders. The National Transportation Safety Board (NTSB) is preparing to take a stand on the issue within weeks, according to testimony at a recent public meeting.
Friday, January 02, 2009
Sleep and coronary artery calcification
Several medical bloggers have posted about a recent study in which increased sleep time was associated with a decreased incidence of coronary artery disease (as measured by coronary artery calcification).
The problem with these observational studies looking at sleep duration and mortality/morbidity is that they don't distinguish between 1) voluntary sleep deprivation, 2) primary insomnia, and 3) insomnia secondary to medical/sleep disorders.
How is a doctor to use the data from this study???
I doubt writing a prescription for a sleeping pill would improve someone's coronary artery calcification score. However, advising someone with voluntary sleep deprivation (due to work pressures, etc) to extend their sleep hours might (if they take your advice)- I base this conclusion on prior studies which demonstrated that voluntary sleep restriction does lead to adverse metabolic consequences. And of course, treating any obstructive sleep apnea present is important, especially in patients with pre-existing coronary artery disease, atrial fibrillation, or congestive heart failure.
The problem with these observational studies looking at sleep duration and mortality/morbidity is that they don't distinguish between 1) voluntary sleep deprivation, 2) primary insomnia, and 3) insomnia secondary to medical/sleep disorders.
How is a doctor to use the data from this study???
I doubt writing a prescription for a sleeping pill would improve someone's coronary artery calcification score. However, advising someone with voluntary sleep deprivation (due to work pressures, etc) to extend their sleep hours might (if they take your advice)- I base this conclusion on prior studies which demonstrated that voluntary sleep restriction does lead to adverse metabolic consequences. And of course, treating any obstructive sleep apnea present is important, especially in patients with pre-existing coronary artery disease, atrial fibrillation, or congestive heart failure.
Saturday, December 20, 2008
Billing for Interrupted Sleep Studies
This appeared in the current issue of Medical Economics (I am quoting it in full to better illustrate how wrong the answer is):
Q: We perform sleep and polysomnography studies, which are frequently interrupted because the patient repeatedly stops breathing and we need to implement continuous positive airway pressure therapy. Until now, we didn't think we could bill for those interrupted studies, but we were recently told it is appropriate to do so. How do we proceed?
A: There are actually two proper ways to report the service, according to Current Procedural Terminology. The first is to report the appropriate code from the 95803-95811 range with the modifier –52 for reduced services. The second is to report the appropriate code with the modifier –53 for discontinued services.
The modifier selection would be determined by the amount of data collected during the study. If there is sufficient data to form a diagnostic opinion, –52 would seem the appropriate choice. If there is insufficient data, modifier –53 would be appropriate. However, it is a decision that should be made by the physician. As you know, CPT definition does not guarantee coverage by the insurer.
Q: We perform sleep and polysomnography studies, which are frequently interrupted because the patient repeatedly stops breathing and we need to implement continuous positive airway pressure therapy. Until now, we didn't think we could bill for those interrupted studies, but we were recently told it is appropriate to do so. How do we proceed?
A: There are actually two proper ways to report the service, according to Current Procedural Terminology. The first is to report the appropriate code from the 95803-95811 range with the modifier –52 for reduced services. The second is to report the appropriate code with the modifier –53 for discontinued services.
The modifier selection would be determined by the amount of data collected during the study. If there is sufficient data to form a diagnostic opinion, –52 would seem the appropriate choice. If there is insufficient data, modifier –53 would be appropriate. However, it is a decision that should be made by the physician. As you know, CPT definition does not guarantee coverage by the insurer.
Occasionally a patient comes in for a diagnostic polysomnogram (95810) and due to the severity of the sleep apnea, CPAP is applied (while continuing polysomnographic monitoring). Sometimes patients are scheduled for split-night studies, in which for the first several hours diagnostic polysomnography is performed, and if there appears to be significant sleep apnea, cpap is applied for the rest of the night with continued polysomnographic monitoring. In both of these situations, the correct CPT billing code to use is (95811), the code for a CPAP titration study.
I am not too familiar with the -53 modifier. I use the -52 modifier when a study is terminated prior to 6 hours of recording time. I do plan to look more into the difference between the -52 and -53 modifiers.
On a broader note, this answer in Medical Economics-written by a non-physician- illustrates that the field of Medicine needs physicians with legal and business experience, and perhaps dual degrees (MD/JD and MD/MBA). Non-physicians often have difficulties truly understanding what what is involved in a medical business. For example, sleep labs organized as Independent Diagnostic and Testing Facilities (IDTF's) that have physician ownership or part ownership are limited in the number of referrals that can come from the physician. Say, for example, that an IDTF with a physician owner and several non-physician owners is told by their lawyer that only 40% of the sleep studies can be ordered/referred by the physician owner. Seems simple enough. However, how do you count a cpap titration? If a Primary care doc orders the psg, it shows sleep apnea, the sleep doc - who is a part owner of the IDTF- sees the patient and arranges for the titration study, who is considered to be the referring doc for the cpap titration? Does it make any difference if the original order form signed by the primary care doc has a pre-printed line next to the order for the polysomnogram indicating that a cpap titration will be performed if clinically appropriate? In my experience, many lawyers have difficulties understanding the process by which a patient initially presents with symptoms of OSA and, after seeing several doctors and going through several sleep studies, eventually receives a cpap machine. I think that part of the problem is that Federal regulations are unclear on the matter. We probably need more doctors in government, too.
Thursday, November 13, 2008
Objective Compliance Documentation for CPAP use
A member of the AASM discussion boards provide a link to the following info regarding the new CMS requirements for the documentation of benefit of CPAP required for continued coverage of cpap beyond the initial 3 month period:
For PAP devices with initial dates of service on or after November 1, 2008, documentation of clinical benefit is demonstrated by:
Face-to-face clinical re-evaluation by the treating physician with documentation that symptoms of obstructive sleep apnea are improved; and,
Objective evidence of adherence to use of the PAP device, reviewed by the treating physician.
I am planning on asking the durable medical equipment companies I work with to provide me with a compliance download for my Medicare patients. The Medicare patients will bring this printout to their appointments with me.
This LCD applies to most of the southern states, I believe that most other regions have similar LCD's.
For PAP devices with initial dates of service on or after November 1, 2008, documentation of clinical benefit is demonstrated by:
Face-to-face clinical re-evaluation by the treating physician with documentation that symptoms of obstructive sleep apnea are improved; and,
Objective evidence of adherence to use of the PAP device, reviewed by the treating physician.
I am planning on asking the durable medical equipment companies I work with to provide me with a compliance download for my Medicare patients. The Medicare patients will bring this printout to their appointments with me.
This LCD applies to most of the southern states, I believe that most other regions have similar LCD's.
Tuesday, April 29, 2008
Postpolio syndrome
ADVANCE magazine has an interesting article about Postpolio syndrome, focusing on respiratory disturbances:
Disordered breathing is among the most misdiagnosed and misunderstood symptoms polio survivors face later in life. Too often their breathlessness and inefficient coughs are misdiagnosed as asthma or chronic obstructive pulmonary disease. For many aging polio survivors, it largely has been up to them to initiate their care and educate their doctors on the medical literature.
One-third to one-half of polio survivors experience new or increased weakening and pain in the muscles later in life. This typically occurs 10 to 40 years after recovering from original polio. This weakening can affect the diaphragm and breathing muscles, causing such disorders as obstructive sleep apnea, central sleep apnea, pneumonia, pulmonary restriction, shallow breathing, pneumonia, and diffuse muscle twitching during sleep.
He warns that split-night sleep studies are not appropriate for polio survivors I agree with this; home testing is not appropriate either.
Polio survivors should be given portable volume-pressure ventilators to use with nasal interfaces for ventilatory assistance rather than CPAP or bilevel positive airway pressure, Dr. Bach said. Polio survivors do not benefit from the expiratory positive pressure, he said, and it detracts from the positive inspiratory pressure in assisting the inspiratory muscles.
I disagree, many do have some element of obstructive sleep apnea and benefit from BiPAP. Typically these patients do require a wide differential between the EPAP and IPAP.
A few patients still use the iron lung, a form of negative pressure ventilation. Negative pressure ventilation can predispose to or worsen obstructive sleep apnea, but is very effective in some patients with postpolio syndrome.
Disordered breathing is among the most misdiagnosed and misunderstood symptoms polio survivors face later in life. Too often their breathlessness and inefficient coughs are misdiagnosed as asthma or chronic obstructive pulmonary disease. For many aging polio survivors, it largely has been up to them to initiate their care and educate their doctors on the medical literature.
One-third to one-half of polio survivors experience new or increased weakening and pain in the muscles later in life. This typically occurs 10 to 40 years after recovering from original polio. This weakening can affect the diaphragm and breathing muscles, causing such disorders as obstructive sleep apnea, central sleep apnea, pneumonia, pulmonary restriction, shallow breathing, pneumonia, and diffuse muscle twitching during sleep.
He warns that split-night sleep studies are not appropriate for polio survivors I agree with this; home testing is not appropriate either.
Polio survivors should be given portable volume-pressure ventilators to use with nasal interfaces for ventilatory assistance rather than CPAP or bilevel positive airway pressure, Dr. Bach said. Polio survivors do not benefit from the expiratory positive pressure, he said, and it detracts from the positive inspiratory pressure in assisting the inspiratory muscles.
I disagree, many do have some element of obstructive sleep apnea and benefit from BiPAP. Typically these patients do require a wide differential between the EPAP and IPAP.
A few patients still use the iron lung, a form of negative pressure ventilation. Negative pressure ventilation can predispose to or worsen obstructive sleep apnea, but is very effective in some patients with postpolio syndrome.
Tuesday, April 22, 2008
"Moderate" does not mean "Mild"
I was in clinic most of the day. I told 2 of the patients that their sleep studies showed "moderate sleep apnea". Both of them looked relieved and said almost exactly the same thing, "so it's not that serious?" This necessitated additional time to explain that moderate obstructive sleep apnea is indeed a significant condition that usually affects daytime functioning as well as cardiovascular health.
I'm not sure why this confusion occurred. Maybe "moderate" means something different to lay people than physicians.
I guess I should change my classification, when speaking with patients, to "mild obstructive sleep apnea", "obstructive sleep apnea," and "severe obstructive sleep apnea" to promote clarity.
I'm not sure why this confusion occurred. Maybe "moderate" means something different to lay people than physicians.
I guess I should change my classification, when speaking with patients, to "mild obstructive sleep apnea", "obstructive sleep apnea," and "severe obstructive sleep apnea" to promote clarity.
Monday, March 31, 2008
Symphony of Destruction
Sleep Review Magazine has a Podcast series on portable monitoring. The series starts off with a talk by Mary Susan Esther, MD, President-elect of the AASM. Dr. Esther's talk is followed by that of Dr. Chediak, current AASM President. In the coming days, talks will be added by industry representatives.
Tuesday, March 18, 2008
Type 4 Devices for Home Testing for OSA
I received the press release below via email. The two main type 4 devices that meet CMS criteria for home testing for OSA are the Itamar Watch-PAT100 and the Resmed ApneaLink (with the optional oximeter). Neither device is acceptable by the AASM for accredited sleep centers. The AASM has approved certain type 3 devices for accredited sleep centers.
Press Release
Hold until 18:00 (13 March, 2008)
"Watch-PAT100 included as an accepted ambulatory device for Medicare and Medicaid beneficiaries"
Itamar Medical Inc. is pleased to report that the Centers for Medicare and Medicaid Services (CMS) has released today its final National Coverage Decision (NCD) where it has decided to cover the Watch-PAT 100 for home diagnosis of obstructive sleep apnea. This decision will make the Watch-PAT available to Medicare beneficiaries nationwide.
"Today's decision will mean that Medicare beneficiaries in the United States will have access to one of the most accurate, convenient, and cost-effective home sleep testing diagnostic device for sleep apnea," said Itamar Medical Inc. CEO Israel Schreiber. "Medicare now joins the Department of Veterans Affairs, Kaiser Permanente, and other organizations and physicians nationwide in recognizing the usefulness and benefits of Watch-PAT in the diagnosis of sleep apnea."
"The Watch-PAT is already a widely used home sleep testing device, and this coverage decision means that all Medicare beneficiaries suspected of having obstructive sleep apnea will have access to a device that was designed to provide uniquely convenient and comfortable use with proven accurate and reliable performance," said Gary Sagiv, Itamar Medical Inc's Vice President.
Press Release
Hold until 18:00 (13 March, 2008)
"Watch-PAT100 included as an accepted ambulatory device for Medicare and Medicaid beneficiaries"
Itamar Medical Inc. is pleased to report that the Centers for Medicare and Medicaid Services (CMS) has released today its final National Coverage Decision (NCD) where it has decided to cover the Watch-PAT 100 for home diagnosis of obstructive sleep apnea. This decision will make the Watch-PAT available to Medicare beneficiaries nationwide.
"Today's decision will mean that Medicare beneficiaries in the United States will have access to one of the most accurate, convenient, and cost-effective home sleep testing diagnostic device for sleep apnea," said Itamar Medical Inc. CEO Israel Schreiber. "Medicare now joins the Department of Veterans Affairs, Kaiser Permanente, and other organizations and physicians nationwide in recognizing the usefulness and benefits of Watch-PAT in the diagnosis of sleep apnea."
"The Watch-PAT is already a widely used home sleep testing device, and this coverage decision means that all Medicare beneficiaries suspected of having obstructive sleep apnea will have access to a device that was designed to provide uniquely convenient and comfortable use with proven accurate and reliable performance," said Gary Sagiv, Itamar Medical Inc's Vice President.
Friday, March 14, 2008
Another Update on Home Testing for OSA
Several weeks ago I posted that regional Medicare carriers in many states decided not to cover home testing. Apparently those decisions are not in effect and the new national decision takes precedence:
That's because CMS has not yet released its final decision on whether to cover at-home based sleep tests. The decision, expected March 13, will likely favor the proposal. Until then, local coverage policy cannot be updated, said Dr. Hughes."Until the rules change, the rules are what they are," he said.
So basically, the new CMS decision overrides any pre-existing rules, but now that there has been a national decision, local coverage policy can be updated (at least that's my understanding, it's a confusing issue).
That's because CMS has not yet released its final decision on whether to cover at-home based sleep tests. The decision, expected March 13, will likely favor the proposal. Until then, local coverage policy cannot be updated, said Dr. Hughes."Until the rules change, the rules are what they are," he said.
So basically, the new CMS decision overrides any pre-existing rules, but now that there has been a national decision, local coverage policy can be updated (at least that's my understanding, it's a confusing issue).
Saturday, November 17, 2007
More on Auto-CPAP
Currently there are a few major financial barriers to the use of Auto-CPAP:
Medicare and most insurance companies reimburse the DME companies for Auto-CPAP at the same rate as a regular CPAP machine. Auto-CPAP machines are more expensive (for the DME company) than regular CPAP machines. Unless a DME company is able to negiotiate a discount with the manufacturer, DME companies typically lose money on Auto-CPAP machines.
As far as using Auto-CPAP for an "at home titration study" (number 3 on my previous post)- that titration period (typically 3 nights) currently is unreimbursed and I am not aware of any plans for reimbursement for this.
-------------------------------
When portable testing is approved, I think that some primary care physicians will try to evaluate and treat osa without the involvement of sleep specialists by ordering portable testing and then treating the patient with an auto-CPAP machine (number 2 on my previous post). The auto-CPAP manufacturers have been known to negotiate discounts with large DME companies so this may be financially possible in certain areas. I think that we will see more auto-CPAP use by primary care doctors over the next several years, along with a temporary increase in profits by the Auto-CPAP manufacturers. However, results will be poorer than the current standard of having a patient undergo an in-lab titration before prescribing cpap. A lot of auto-cpap machines will end up sitting in closets and the auto-cpap trend will end by 2012.
Medicare and most insurance companies reimburse the DME companies for Auto-CPAP at the same rate as a regular CPAP machine. Auto-CPAP machines are more expensive (for the DME company) than regular CPAP machines. Unless a DME company is able to negiotiate a discount with the manufacturer, DME companies typically lose money on Auto-CPAP machines.
As far as using Auto-CPAP for an "at home titration study" (number 3 on my previous post)- that titration period (typically 3 nights) currently is unreimbursed and I am not aware of any plans for reimbursement for this.
-------------------------------
When portable testing is approved, I think that some primary care physicians will try to evaluate and treat osa without the involvement of sleep specialists by ordering portable testing and then treating the patient with an auto-CPAP machine (number 2 on my previous post). The auto-CPAP manufacturers have been known to negotiate discounts with large DME companies so this may be financially possible in certain areas. I think that we will see more auto-CPAP use by primary care doctors over the next several years, along with a temporary increase in profits by the Auto-CPAP manufacturers. However, results will be poorer than the current standard of having a patient undergo an in-lab titration before prescribing cpap. A lot of auto-cpap machines will end up sitting in closets and the auto-cpap trend will end by 2012.
Wednesday, October 03, 2007
Opioids and sleep apnea
Opioids such as methadone are well known to cause central sleep apnea. Sleep Review Magazine reports a high rate of obstructive and central sleep apnea in patients who use opioids for chronic pain:
Sleep-disordered breathing is very common in patients who use opioids for chronic pain conditions, according to a report issued online September 6th by the journal Pain Medicine.
Of the 147 patients on chronic opioid therapy who agreed to undergo testing, 140 had data available for analysis, the report indicates.
"The biggest finding was an extraordinarily high prevalence of sleep-disordered breathing in opioid-treated chronic pain patients," Dr. Webster noted. "Obstructive and central sleep apnea syndromes occurred in the studied population at a far greater rate (75%) than is observed in the general population."
The most common type of sleep apnea, seen in 39% of all patients, was the obstructive type, followed by central sleep apnea in 24%, central and obstructive sleep apnea in 8%, and indeterminate type in 4%.
The apnea-hypopnea index was directly related to the daily dosage of methadone, but not to that of other opioids (p = 0.002). The central apnea index was directly linked to the daily dosage of both methadone (p = 0.008) and benzodiazepines (p = 0.004).
It is interesting that in this study methadone appeared to have a greater effect on sleep apnea than other opioids.
I run a suboxone clinic to treat persons addicted to opioids. I'll have to increase my monitoring of their sleep.
Sleep-disordered breathing is very common in patients who use opioids for chronic pain conditions, according to a report issued online September 6th by the journal Pain Medicine.
Of the 147 patients on chronic opioid therapy who agreed to undergo testing, 140 had data available for analysis, the report indicates.
"The biggest finding was an extraordinarily high prevalence of sleep-disordered breathing in opioid-treated chronic pain patients," Dr. Webster noted. "Obstructive and central sleep apnea syndromes occurred in the studied population at a far greater rate (75%) than is observed in the general population."
The most common type of sleep apnea, seen in 39% of all patients, was the obstructive type, followed by central sleep apnea in 24%, central and obstructive sleep apnea in 8%, and indeterminate type in 4%.
The apnea-hypopnea index was directly related to the daily dosage of methadone, but not to that of other opioids (p = 0.002). The central apnea index was directly linked to the daily dosage of both methadone (p = 0.008) and benzodiazepines (p = 0.004).
It is interesting that in this study methadone appeared to have a greater effect on sleep apnea than other opioids.
I run a suboxone clinic to treat persons addicted to opioids. I'll have to increase my monitoring of their sleep.
Wednesday, September 12, 2007
I am not Responsible for your CPAP Machine
CPAP (Continuous Positive Airway Pressure) is the most common treatment for obstructive sleep apnea. Most sleep physicians do not directly provide their patients with CPAP machines, but instead give a prescription for each patient to take to a durable medical equipment (DME)company. I typically give patients a list of several companies to choose from, while telling them that they are legally free to pick any DME company they desire.
===============
Once a patient selects a DME company, he is essentially stuck with that company for 5 years. Due to reimbursement issues, it is difficult to switch companies (though there are a few exceptions- insurance reimbursement for CPAP is a complicated matter). Choosing the right DME company is critical- the DME company is responsible for adjusting the settings (as ordered by a physician prescription), supplying/fitting CPAP masks, periodically replacing filters and other supplies, and servicing the CPAP machines.
So pick a good DME company- go with your doctor's suggestion.
-----------------------------------
Do not lose your CPAP machine. There is nothing I can do about it. Medicare and most other insurance companies won't cover a new CPAP machine for 5 years, unless your machine becomes unrepairable. If you lose your machine, you are out of luck.
--------------------------------
If you plan on moving soon, pick a national DME company, such as Lincare or Apria. If your DME company does not have an office in the state you are moving to, it may be difficult to get your CPAP machine serviced.
--------------
I am not responsible for your CPAP machine. If it malfunctions, I will try to help out and will call your DME company, if necessary. However, I am often limited in what I can do. If you are one of my patients, please go to one of the companies that I recommend. I only recommend companies that provide good service.
===============
Once a patient selects a DME company, he is essentially stuck with that company for 5 years. Due to reimbursement issues, it is difficult to switch companies (though there are a few exceptions- insurance reimbursement for CPAP is a complicated matter). Choosing the right DME company is critical- the DME company is responsible for adjusting the settings (as ordered by a physician prescription), supplying/fitting CPAP masks, periodically replacing filters and other supplies, and servicing the CPAP machines.
So pick a good DME company- go with your doctor's suggestion.
-----------------------------------
Do not lose your CPAP machine. There is nothing I can do about it. Medicare and most other insurance companies won't cover a new CPAP machine for 5 years, unless your machine becomes unrepairable. If you lose your machine, you are out of luck.
--------------------------------
If you plan on moving soon, pick a national DME company, such as Lincare or Apria. If your DME company does not have an office in the state you are moving to, it may be difficult to get your CPAP machine serviced.
--------------
I am not responsible for your CPAP machine. If it malfunctions, I will try to help out and will call your DME company, if necessary. However, I am often limited in what I can do. If you are one of my patients, please go to one of the companies that I recommend. I only recommend companies that provide good service.
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