For Release: March 12, 1999
Contact: Kimberly Lynch, ACCP, (847) 498-8341
NEW GUIDELINES RELEASED FOR TREATING ADULT SLEEP APNEA
New treatment guidelines were reported today for one of the fastest growing areas of medicine--sleep disorders. The guidelines appeared in the March issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP).
In the same issue of CHEST, an editorial voiced concern about a growing number of sleep laboratories which lack quality control and are run by physicians who don"št have adequate specialty training.
The guidelines focused on various forms of positive airway pressure (PAP) in the treatment of adult obstructive sleep apnea (OSA), the most common form of sleep apnea which afflicts 20 million Americans. The most effective treatment, continuous positive airway pressure (CPAP), requires the patient to wear a mask over the nose during sleep as pressure from an air compressor forces air though the nasal passages. Although effective, about 40 percent of patients have difficulty using CPAP for long periods of time. Another form, bilevel positive airway pressure (BiPAP) ventilator support system, is designed to follow the patient's breathing pattern which many patients find more comfortable than continuous pressure.
People with obstructive sleep apnea find it difficult to sleep at night and stay awake during the day. The costs to society due to loss of productivity, industrial accidents, and medical bills are estimated to be over $60 billion per year.
The panel of experts which authored the guidelines said they wanted to provide a common sense and easily understood approach to the treatment of OSA with PAP. They said their recommendations were based on peer-reviewed studies and widely accepted clinical practice and should serve as an interim guide until results from research such as the Sleep Heart Health Study and various other evidence outcome studies could provide the data upon which to develop more formal consensus recommendations. They noted that the guidelines do not necessarily reflect the official view of either the American College of Chest Physicians or any of their respective home institutions.
The guidelines cover the following: which patients should undergo such diagnostic techniques as polysomnography, the continuous recording of a number of physiological functions and events during sleep which could range from three to six hours; what criteria should be met to appropriately define apnea (cessation of breathing)and hypoxia (oxygen deficiency); what conditions warrant treatment for which PAP therapy, and what efforts should be undertaken to help patients adhere to their treatment.
In an editorial, one of the guidelines experts, Nancy Collop, M.D., FCCP, of the University of South Carolina, voiced alarm about the many sleep laboratories that have opened which are headed by physicians who don"št have any specific training in sleep medicine. She noted that the American Sleep Disorders Association (ASDA) has an accreditation process for sleep laboratories but she added "accreditation is not required by most states, or more importantly, it is not required by most insurance carriers for reimbursements." Likewise, she pointed out that there is also an American Board of Sleep Medicine (ABSM) that certifies individuals as sleep specialists. She said this certification presumably makes those individuals more qualified to run a sleep laboratory. However, she said, this certification is not required to run a laboratory or to read sleep studies.
"Anyone can open a sleep laboratory, and it seems that just about everyone is," she said. She noted that in a city the size of Charleston, S.C., there were already seven sleep laboratories run by a variety of specialists. Noting that discussions in the past regarding certification, accreditation, quality control and training did not lead to any resolution, she urged that these issues be ritically evaluated by the ASDA, the ABSM, the ACCP, and the American Thoracic Society (ATS).
"As the majority of sleep specialists are pulmonologists," she said, "we must take the lead in resolving these issues."
CHEST is published by the American College of Chest Physicians (ACCP) which represents 15,000 members who provide clinical, respiratory, and cardiothoracic patient care in the U.S. and throughout the world.
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Reporters may wish to call Kimberly Lynch of the ACCP at (847) 498-8341 for a full copy of the article. She can also be reached by fax at (847) 498-5460. The table of contents and the abstracts of all articles appearing in the March issue of CHEST are available on the ACCP web site at Dr. Nancy Collop of the University of South Carolina can be reached by phone at (843) 792-3162 or by email at [email protected].
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