Economic Benefits of Treating OSA

OSA Economics

In August 2016, The American Academy of Sleep Medicine (AASM) published a document entitled Exploring The Economic Benefit of OSA Diagnosis and Treatment. In the publication (also published in thedocument Hidden Health Crisis Costing America Billions), the 2015 cost for undiagnosed obstructive sleep apnea was $150 billion. Because the cost of treating OSA would be only one-third of the cost if left untreated, the cost-savings lost per year for leaving OSA untreated in the vast majority (80%) of candidates approaches (and certainly now exceeds) $100 billion per year in the United States.

In the Testing link we emphasized that there are good clinical arguments for testing all patients with type 2 diabetes mellitus and drug-resistant hypertensives. Now we can appreciate the economic arguments that accrue to that vast untreated patient pool as well.

In particular, the Executive Summary of the AASM publication reports that "(d)irect economic costs can include comorbidities such as high blood pressure or diabetes, motor vehicle or workplace accidents, and compensating behaviors such as the substance abuse of pills, tobacco and alcohol. Indirect economic costs can include decreased productivity at work, reduced quality of life, and stress on interpersonal relationships."
The published survey commissioned by the AASM disclosed that initial physician screening underreported the severity of OSA compared to actual testing (62% mild, 30% moderate, and only 8% severe projected by physician screening compared to objectively verified diagnostic testing results of 16% mild, 43% moderate and 41% severe for the same pool; n=506). This is an  important point considering that patients and PCP's are significantly less motivated to initiate a sleep study if the patient is perceived to be mild.

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Sleep Apnea

By now, many of us have heard about obstructive sleep apnea (OSA), or just "sleep apnea" as it is commonly referred to in public dialogue. OSA is a condition in which the flow of air pauses or decreases during breathing while you are asleep because the airway has become narrowed, blocked, or floppy. A pause in breathing is called an apnea. Impacts from OSA are widespread, including straight-forward dangers related to reduced oxygen delivery and it's impact on the mechanics of the heart, to less intuitive impacts such as the onset or exacerbation of diabetes, obesity, and mental and emotional health disorders by virtue of secondary mechanisms.

The trouble with limiting public discussion of OSA to formal definitions of apneas and their mechanical causes is that many people assume they do not have sleep apnea because they'd KNOW if they stopped breathing during sleep. That is not the case, however.
Our body overcomes and even anticipates upper-airway resistance— of which snoring is a prime indicator, by setting in motion repeated patterns of increased neuromuscular vigor around the upper airway to keep the airway open. The problem is that effort does not always wake you, but it sets in motion adverse effects from OSA, including hypertension, blood sugar problems and cognitive impairment.

It is hard to imagine— but true— that repeated bouts of tiny nerve and muscle signals can have such adverse effects on basic health, including driving persistent hypertension, obesity, and diabetes. After all, these episodes may happen literally hundreds of times per night and we may not even be aware of them. Nonetheless, they disrupt our basic sleep architecture, which means that we do not enter deep, restorative stages of sleep. When that happens, more adverse effects ensue for our mental and emotional health.

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