Reena Mehra, MD, MS: The Struggle to Diagnose OSA


Obstructive sleep apnea has been consistently underdiagnosed in US populations. Are screening methods enough?

Population studies, separated by a decade, have shown obstructive sleep apnea has consistently been undiagnosed, yet widely prevalent, among many at-risk patients in the US. The persisting negligence to the pulmonary sleep condition comes in spite of recent efforts to spread awareness on the disease—and may be combated by new measures to screen, diagnose, and provide care sooner.

In an interview with MD Magazine®, Reena Mehra, MD, MS, director of the Sleep Disorder Research Program at the Cleveland Clinic, explained the recent history of sleep apnea under-diagnosis, and shared the current projects designed to reduce the disease’s overall burden.

MD Mag: Why is obstructive sleep apnea such a chronically underdiagnosed condition?

Mehra: It's really concerning, because it's so widely prevalent. Around 10 to 15% of the population is estimated to have obstructive sleep apnea. And it's been increasing in recognition, at least in terms of awareness, over the last couple of decades.

There are data going back to the mid-2000s range from the Sleep Heart Health study, which is a major study where they studied sleep apnea and its relationship to adverse outcomes. And they found in that study that approximately 85% of the individuals presenting for that study were undiagnosed.

Data more recently published in 2015 shows that its essentially the same—approximately 85 to 90% of those presenting for this population-based health study were newly diagnosed with obstructive sleep apnea. And it appeared underrepresented minorities were the ones most vulnerable to this under-diagnosis.

So it's definitely a persistent issue. In terms of why, it's hard to know why. I think a lot of our societies have been doing a lot to raise awareness, such as the American Academy of Sleep Medicine, the NIH, the National Centers for Sleep Research. There's been a lot of effort to try to increase awareness.

Some of it may be the primary care physicians are oftentimes on the frontline of diagnosing and looking into the possibility of obstructive sleep apnea. And it could be that there's just so much else going on with those patients that it's not their priority list.

Here at the Cleveland Clinic, we're starting to hopefully soon roll out a care path for obstructive sleep apnea, which should make it easier for physicians to 1) think about obstructive sleep apnea and 2) assess for it via a screening instrument. And then it gives them a guide, in terms of how to approach the diagnosis and management of patients with suspected obstructive sleep apnea.

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