Sleep apnea is associated with pulmonary, cardiovascular, psychiatric, neurologic, and weight-related effects. Primary care physicians need to monitor sleep health more.
Just as sleep health is associated with countless conditions and risks in everyday patients, sleep apnea is associated with many known and theorized comorbidities. The caregivers with the greatest responsibility of monitoring sleep health and status are often the front-line treaters: primary care physicians.
In an interview with MD Magazine® while at the American Thoracic Society (ATS) 2019 International Meeting in Dallas, TX, Neomi Shah, MD, MPH, associate division chief of Pulmonary Critical Care & Sleep Medicine at Mount Sinai, explained the important distinction between obstructive sleep apnea and sleep deprivation presented in the primary care office, and how far-reaching sleep apnea comorbidities can be.
MD Mag: What is the role of a primary care provider in addressing a patient’s sleep health?
Shah: I think the main role of a primary care provider is honestly to do a thorough sleep history. And when I say thorough, I know they have a lot of other things that they have to look for, but some of the basic questions are, “Is the person sleepy during the day?” If they're sleepy, we know that sleep apnea treatment works. And it works because it helps improve their daytime function, it helps quality of life, it helps depression scores, and it also potentially helps reduce motor vehicle accidents—although some of the recent trials weren't able to confirm it.
But overall, I think if you have a sleepy patient, you really need to understand whether or not they have obstructive sleep apnea, or whether they're sleep-deprived, or whether they are both. Sleep deprivation we know is not good from a lot of animal work and even early human studies for diabetes risk, for hypertension risk, obesity risk.
So I think a primary care physicians job is really to find out if a person has any sleepiness symptoms in the daytime, and if there is an indication, refer them to tease apart whether it's sleep apnea by doing a sleep study, or looking at whether or not they have other sleep disorders. More commonly, we find that they're just sleep deprived or have short sleep duration because of societal and lifestyle requirements or pressures.
Is healthy sleep an under-looked aspect of overall patient care?
So cardiovascular diseases are 1 domain, but there's neurocognitive impairment, there's daytime functioning, there's mental health. There's a clear signal when you treat sleep apnea, depression improved in clinical trials. I don't think we can really lump all of the outcomes together and say, “Well, sleep apnea doesn't really seem to improve cardiovascular outcomes at least for the time being but we know that it improves all these other things.”
I think appropriately screening, appropriately referring, and diagnosing sleep disorders is very important, because it does have an effect on a lot of health outcomes including obesity, including your dietary intake, which can drive numerous other outcomes and health endpoints.
So yeah, I think we're still in the infancy stages of really trying to understand how sleep apnea affects a lot of these domains, specifically cardiovascular disease.