Quite often, by patients and other physicians, I’ve been accused of over-diagnosing obstructive sleep apnea. From an outsider’s view, it may seem like that may be the case, but my feeling is that if anything, I’m severely under-diagnosing sleep apnea. Here’s my rationale:
It’s been estimated that 80-90% of people with obstructive sleep apnea in this country are not diagnosed. It’s also been my experience that 9 out of 10 times, men and women who fit the classic profile for someone with obstructive sleep apnea (overweight, snores, tired and drowsy, has hypertension and heart disease) never even get considered for obstructive sleep apnea by their medical doctors.
Oftentimes, it’s their spouse, bed-partner, dentist or TV ad that ends up taking them to a doctor. Even when they see their doctors, sometimes they are told that they don’t fit the mold for someone with sleep apnea. Now we know that you can be thin, young, female, and not snore and still have significant obstructive sleep apnea. Some of my most severe sleep apnea patients are young, then women.
Honestly, I have to hold back from ordering sleep studies in my patients, since I literally don’t have enough time in the day to write up the needed requisitions and call patients back with test results. About 90% of the time, I’m correct in my presumptive diagnosis, whereas in the other 10%, they’ll usually have upper airway resistance syndrome. I simply don’t order sleep studies in people with normal upper airway anatomy.
Even if you don’t have obstructive sleep apnea on a sleep study, you can still stop breathing and wake up 25 times an hour. This is called upper airway resistance syndrome, which is a well-described clinical condition. But because it doesn’t make the cutoff for levels needed for obstructive sleep apnea, it’s not covered by insurance, and doctors usually won’t treat it. Sometimes they’ll tell you that you intense fatigue is from some other sleep or medical conditions. Oftentimes, you can have 20 to 30 obstructions and arousals per hour, but since you have only 6 apneas per hour (mild), you’ll be recommended conservative treatment options, positional therapy, or weight loss since you have only “mild” sleep apnea.
But most importantly, if you could look with an endoscope and see the airway in the picture shown above, would you tell them they they only have “mild” sleep apnea and they should lose some weight? If you had to breathe through that tiny slit every night, especially when you know that your throat muscles slacken whenever you reach deep sleep, would you follow your doctor’s advice?