CHEST 2018 Perspectives - Episode 2

Barbara Phillips, MD, MPH, FCCP: The Lack of Specialist Inclusion in Sleep Apnea

With sleep apnea affecting about 10% of the US population—and another 10% potentially going undiagnosed, Barbara Phillips, MD, MPH, FCCP, noted—the patient size is superior to that of other pulmonary conditions, including asthma. But the field still struggles to provide comprehensive care and expedient diagnosis to its patients due to a lack of sleep condition knowledge across specialties.

In an interview with MD Magazine® while at the 2018 CHEST Annual Meeting in San Antonio, TX, last week, Phillips explains the lack of clinical interest towards sleep apnea management, the reticence of the sleep field to include outside specialists, and how those 2 elements result in a lingering issue for patients.

MD Mag: What is the current state of care for sleep apnea?

Phillips: There are people who have severe sleep apnea, however you want to define it, however metric you want to use. There are people who have clearly important sleep-disordered breathing, and they are generally identified fairly readily, and they are started on treatment. I think we have enough infrastructures here, in terms of sleep centers and testing devices, to take care of these people. The problem is now that we don't have enough sleep specialists, and it seems like not many other clinicians are very interested in managing sleep apnea.

There are a lot of reasons for that—some of them historical, some of them political, some of them related to insurance, some of them related to who gets sleep apnea—but the bottom line is there are not enough practitioners of any stripe who are expert in the management of sleep apnea so that once the diagnosis is made, which is the easy part, that patient is followed like any patient with a chronic disease should be, with careful follow-up, feedback, and adjustments as seen necessary.

I would say the current state right now is not very good.

MD Mag: Why may there be a lack of clinical understanding of sleep apnea among specialists in other fields?

Phillips: To be brutally honest, and somewhat finger-pointing, I would lay some of the responsibility for this at the foot of professional organizations that represent sleep physicians, and has tended to own, corner, and control the market on the diagnosis and management of these patients—excluding others. And that's just not sustainable, because we have a condition here that is far more prevalent than asthma, and we understood a long time ago that pulmonary specialists can't manage every asthma patient.

We need help, from primary care practitioners, even nurse practitioners, to manage that prevalent, deadly disease. And that realization, that understanding, that dissemination of knowledge about sleep apnea to non-sleep specialists hasn't really happened yet. And I think it's a mistake that the field has made, and by that, I mean the sleep field.

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