Sleep Apnea and Health Care redux

I have commented elsewhere in this journal about the value of being in Washington. This past week was another example of the opportunities that present themselves when you are located in the Nation's Capital.

At the beginning of the week I attended a forum entitled “Health care reform, what's next?” This event had been postponed two weeks previously owing to the shootings in Tucson and before the vote in the House of Representatives to repeal the Affordable Care Act.

I go to these events, like most, hoping to gain some nugget of insight that might otherwise not make it through the media's filter. Another reason, again why most go, is the networking opportunity the gatherings provide. Hey, this is Washington.

The nugget for me came from Republican pollster Bill McInturff. who indicated that the majority party in the House of Representatives had nothing to “replace” what they had recently “repealed.” Without an alternative, HR 2 would go nowhere.

Unfortunately, I had to leave early and so had to miss the comments of Neera Tanden. Her perspective on how health care reform has evolved, given that she has been working on it since the beginning, would have been interesting.

I shared a table at the event with someone in federal affairs from AHIP, America’s Health Insuance Plans, the health-insurance lobby, and used the opportunity to remind my companion how important it is that health insurers provide coverage for the diagnosis and treatment of sleep apnea.

I left early to attend a briefing by the Nancy Brown, CEO of the American Heart Association, on a new economic study by her organization on the future cost of heart disease. My interest in attending the briefing was to introduce myself to her, which I did after the meeting. But I also used the briefing to raise a question about the role of healthy sleep in preventing heart disease. She wasn't quite ready for that question, though she did admit that quality sleep was important to her.

When I did get a chance to speak with her, she acknowledged that sleep is important and that there is some evidence of a causal relationship between OSA and heart disease, but she stressed the need for better medical evidence of the relationship. I was reminded of the summary section from an article that appeared in a 2008 issue of Circulation, the AHA journal, that highlighted numerous hurdles facing heart specialists in developing best practice principles to limit the adverse cardiovascular impact of sleep apnea.

We exchanged business cards. We have subsequently exchanged e-mails. We'll see what happens.

At the end of the week I was back at the National Press Club, this time for a briefing by the president of the American College of Physicians, Fred K. Ralston, M.D. ACP is the medical professional society that represents 130,000 general practice physicians in the United States. Ralston presented the State of the Nation's Health Care 2011. The ACP supports the Affordable Care Act, but sees room for improvement.

The ASAA has not taken a position on the law. Our concern has to make sure that diagnosis and treatment of sleep apnea is covered. We have asked visitors to our web site to write to HHS Secretary Sebelius requesting that coverage be included as the rules and regulations for the law’s administration are drawn up.

The points made by the ACP and its interest in pursuing “High Value, Cost Conscious Care” makes a lot of sense. Our own experience is that early diagnosis and treatment of sleep apnea can significantly reduce the cost of health care down the line.

We will explore further working with the ACP to educate primary care physicians, nurse practitioners, and physician assistants about sleep apnea and the benefits of treatment.

Sleep Apnea and Healthy People 2020

The sleep community realized a small victory last year. It could be a large victory, it depends on how our fragmented community decides to move forward.

The Department of Health and Human Services develops, every 10 years, a set of objectives to guide health policy for the citizens of the United States.
Quoting from the web site:

Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to:

• Encourage collaborations across sectors.
• Guide individuals toward making informed health decisions.
• Measure the impact of prevention activities.

 Previously issues around improving sleep in young people and adults were spread across various topics. In the recently released document, sleep health has its own. The first objective listed under this topic:

SH-1     Increase the proportion of persons with symptoms of obstructive sleep apnea who seek medical evaluation.

That could be the mission statement of the association.

Now we can point to something that indicates the Federal government is concerned about the number of people with sleep apnea symptoms who aren't seeking medical evaluation.

Satisfactory accomplishment of the objective would to increase the number of persons with symptoms to seek medical evaluation by 2.5% over the course of the next 10 years.

Sounds do-able!

But in order to accomplish this objective we will need increase awareness about sleep apnea - believe it or not, there are still people who don't know what sleep apnea is - why would they; it is something that happens while they are sleeping and the only evidence of the problem could awakening unrefreshed and/or complaints from their bedpartner (if they still have one).

There is a second population that needs increased awareness - primary care medical professionals - family practice physicians, internists, nurse practitioners and physicians assistants. Let's include dentists and oral hygenists as well since they see people with symptoms more often than the others.

The ASAA will do its part. Not only making people aware of the negative consequences of not seeking medical evaluation, but, and more importantly, reminding people of the benefits of treatments - the improvement in the quality (not just the quantity) of life.

If you are concerned about undiagnosed/untreated sleep apnea in yourself or in someone important to you, contact the the American Sleep Apnea Association or visit the web site - http://www.sleepapnea.org/ - let's get to 3%.

Happy New Year!