Barbara Phillips, MD: Sleep Apnea Diagnosis is Too Complicated


Sleep apnea is a common condition with an impact that goes beyond the affected patient. Diagnosis and treatment need to change to a more patient-centric model in order to improve outcomes and reduce risks.

Quickly and accurately diagnosing sleep apnea is critical, according to Dr Barbara Phillips, because the condition is common and its symptoms have the potential to affect just about anybody.


Probably, depending on how it's defined, about 10% of the American population has obstructive sleep apnea. This is a risk factor for hypertension, stroke, death, atrial fibrillation, car crash, and a lot of things that can affect not just the person who has it, but also their bed partner, or the person in the shotgun seat, or oncoming lane. So it actually is a public health problem of some magnitude.

The diagnosis and management of sleep apnea to this point, has been, in my view, too complicated, too time consuming, too expensive, too patient unfriendly, too test-oriented and not nearly enough follow up chronic management oriented.

That is changing. It has to change. There is a professional organization that continues to insist that physicians who are board certified in sleep medicine be reimbursed for reading the sleep studies, which is where the money has traditionally been, and which, I can tell you, is not rocket science.

The management, follow-up and actual care of patients has just been sort of willy-nilly, slip-shod, not necessarily done by people who even understand what a sleep study means. As a result, the vast majority of people with sleep apnea remain undiagnosed.

They don't want to bother with all of this expensive testing, or maybe they have the test, but they never even get any follow-up. And many people who are prescribed effective treatment don't use it, again, because chronic use of any treatment requires ongoing encouragement, education, follow-up adjustment, and care, which has really not been a huge focus of professional organizations, which seem to be a little bit more focused on testing than on actually taking care of patients.

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