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New MyApnea Blog post-- Study Suggests Women May Be Undertreated for Sleep Apnea

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RebeccaR +0 points · 4 months ago Original Poster Support Team

Some interesting new research has been published about how we recognize and diagnose sleep apnea. For a long time, OSA has had the reputation of being a man’s disease. A new study shows that OSA may be a women’s disease too- we just haven’t applied sex-appropriate methods for diagnosing it. We just published a summary of this new research on the MyApnea Blog! Read more here: https://myapnea.org/blog/2019/12/study-suggests-women-may-be-undertreated-for-sleep-apnea

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Sierra +0 points · 4 months ago Sleep Patron

It is an interesting article but my observation is that sleep apnea treatment is driven by medicare and insurance companies. Changes seem unlikely to occur unless they change their standards for diagnosis. Most will not even recognize RDI as a valid measure to prescribe CPAP equipment.

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Biguglygremlin +0 points · 4 months ago Sleep Enthusiast

I won't win any votes for my contribution here but it seems to me that although the effort and motive may be commendable this approach is tantamount to grabbing an unwanted tool by entirely the wrong end.

Why would you want more women to have this accursed disorder?

Surely this is not an effort to increase influence or funding?

If women want another disorder wouldn't it be more appropriate to start with abnormal and problematic symptoms and proven or provable risks and not with the diagnosis process.

The existing diagnosis process presumably relates to actual symptoms and potential risks. What basis is there to argue that the same factors do not apply to women?

Obviously if the methods and parameters and thresholds are adjusted we could prove that all primary school children have severe Apnea but to what purpose?

I know my queries are provocative but I can't help thinking that this is all upside down.

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Sierra +0 points · 4 months ago Sleep Patron

Seems to me there are two issues here. One is simple and the other much more complex.

First there can be no justification in setting the diagnosis outcomes differently for women than for men. It could be that men are over diagnosed and women are not. Or, the reverse, men are diagnosed properly and women are under diagnosed. I suspect that was the main point of the article.

Second is the issue of whether or not we are over treating sleep apnea. Valid question, and much harder to rationalize. In the UK where their NHS pays for CPAP equipment, they will not give you a machine unless AHI is over 15. They don't treat mild apnea with a CPAP, unless you pay for it yourself. In North America government and private health care companies generally accept that treatement should start at AHI over 5, or Mild Apnea. Which is right is a worthy debate. Are the costs, no matter who pays for them, justified in preventing adverse outcomes?

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Biguglygremlin +0 points · 4 months ago Sleep Enthusiast

They would need a scientific argument and justification but I think the diagnosis process could be made adjustable for gender or weight or height or lung capacity or any number of other potentially relevant criteria but it seems to me that, in the absence of serious symptoms, it is largely unnecessary because the entire science underlying APNEA is extremely vague anyway so there is already a great deal of flexibility when it comes to interpretation and application.

I was pretty unfocused when I read the above blog so I may have misunderstood but it seems to me that if they change the target of the diagnosis process and not just the thresholds then they would probably need to redefine the disorder that they are attempting to diagnose.

They are essentially looking for a new disorder.

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RebeccaR +0 points · 4 months ago Original Poster Support Team

My understanding of the article is that the current way that sleep apnea is commonly diagnosed may not include people who have a dangerous level of apneas. Scientists are learning a lot more about complex factors that characterize Sleep Apnea (timing of AHIs, REM vs. non-REM sleep, oxygen desaturation, airway collapsability, arousal thresholds etc.).

They are also learning more about the epidemiology of sleep apnea and asking really important questions such as 'Are all patients with untreated sleep apnea at high risk for cardiovascular disease? or just some? If so, what characterizes the higher risk patients and how can we make sure they get the best treatment?'

So researchers are not looking for new diseases. Rather they are scrutinizing the way the disease has been diagnosed. They are exploring sleep data in new and more granular ways to see if we are actually capturing everyone who is at risk when we use traditional cut-offs (AHI>15).

According to this new research, it may be that AHI scores should be weighted to differentiate between apneas that happen during REM sleep vs. non-REM sleep, since there is growing evidence that sleep apneas during REM sleep are more strongly associated with cardiovascular risks AND women tend to have a large number of apneas during REM (according to the data in this study).

Does that make sense?

And yes Sierra- I agree that medicare and insurance companies drive treatment and changing those standards is hard. But, change is possible. And the field of sleep should at least work to define risky forms and levels of sleep apnea as accurately as possible (and hopefully understand which forms/levels are most dangerous and which are best suited to which treatment approaches). Then, we can start the work of convincing the insurance companies to get on board with the evidence-based definitions. And they might be easily convinced if the data shows that treating sleep apnea differently can save them $$$ down the line!

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Biguglygremlin +0 points · 4 months ago Sleep Enthusiast

Yes it does make sense and, having a REM disorder myself, I can see why events during REM would be of special concern.

I've read the blog and the abstract but is there some way that I can read the main body of the report?

(You do not currently have access to this article.)

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RebeccaR +0 points · 4 months ago Original Poster Support Team

When I used this link, I was able to scroll down to see the whole article. Does that work for you? https://academic.oup.com/sleep/advance-article/doi/10.1093/sleep/zsz274/5613151

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Biguglygremlin +0 points · 4 months ago Sleep Enthusiast

No, I don't have authorisation from that site, but I managed to gain access through the local university.

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RebeccaR +0 points · 4 months ago Original Poster Support Team

Nice!

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