Commitment and Consistency: Sleep Apnea In The Medical Community

December 24, 2009

With all the studies linking untreated obstructive sleep apnea with heart disease, car accidents, high blood pressure, depression, stroke, and various other common medical conditions, it’s surprising to me that not more doctors are looking for or screening for a condition that exists in 24% of all men and 9% of all women. We screen routinely for conditions that occur in 1-2% of the population that are much less deadly, but with sleep apnea, there’s a mental block that keeps physicians from diagnosing 90% of the people who have it.

Dr. Robert Cialdini, a social physchologist, in his classic book, Influence: The Psychology of Persuasion, describes this phenomenon as commitment and consistency. He states that once you’ve committed to a certain statement, truth, or paradigm, that your subsequent thoughts, words and actions will always be consistent with your original statements or actions. One simple example is an innocent lie that perpetuates more and more lies to cover up the original lie.

In medicine, we have a number of fundamental beliefs, including the fact that germs can cause illness and disease, and that antimicrobial medications can cure these conditions. Only 200 years ago, bad humors and toxins in your blood was removed with blood-letting. If you proposed back then that an unseen germ can cause illness, you’ll be laughed at or even imprisoned for such a wild and ludicrous statement. Galileo was imprisoned under house arrest for his explanation of our sun-centered solar system. I’m sure that 100 years from now, we’ll look at what we’re doing now in medicine will also seem barbaric and primitive.

Western medicine has a clinical diagnosis for almost every ailment we can imagine. There are a number of overlapping features, but for the most part, conditions such as diabetes, heart disease, depression, cold hands, migraines or diarrhea are treated as independent diseases, with different options for treatment. Eastern medicine, on the other hand, proposes that there are only a small number of basic fundamental imbalances that can lead to a number of common symptoms.

Obstructive sleep apnea today is classified alongside thousands of other common and esoteric medical diagnoses, and so to propose that obstructive sleep apnea may be the root cause of a number other other conditions would be considered heresy. Knowing that most people with heart attacks will have obstructive sleep apnea, suddenly screening and treating for sleep apnea in every patient with heart disease will only confirm that if you treat sleep apnea first, then heart disease won’t happen as much. Not only does it bruise our delicate physician egos, it also affects the bottom line for the entire medical industry, which is based on waiting until things get really bad before treating it. To go this route would be to admit that the way we’re practicing medicine is fundamentally wrong, and that would also open up liability issues as well.

Physicians and the lay public are definitely more aware of obstructive sleep apnea, but to date, we’re still treating it as a separate condition, independent of other medical conditions, rather than looking at it from the big picture. Also, despite numerous studies showing that you don’t have to be overweight or even snore to have obstructive sleep apnea, most doctors still won’t consider obstructive sleep apnea unless you fit the typical profile.

What we need is a major paradigm shift in medicine. Unfortunately, I don’t see that happening anytime soon. Do you think I’m being too pessimistic by not giving the medical profession enough credit? Please enter your reaction to this blog by typing your comments in the box below.

Written by Steven Park · Filed Under Blog | 2 Comments

Mandatory Sleep Apnea Screening for Everyone?

October 23, 2009

This is an incredible story, but unfortunately, it probably happens more often than you think. The NTSB (National Transportation and Safety Board) recently investigated a Hawaiian airline incident where both pilots fell asleep and missed their destination by 18 minutes. Air traffic control was able to wake up the pilots, who turned around and landed the passenger plane safely. The captain was later diagnosed with obstructive sleep apnea.

There are numerous other reports of train, bus and tracker trailer accidents, many of them fatal due to the driver having suspected obstructive sleep apnea.

After a long investigation, the NTSB recommended that all long-distance truckers, airline pilots, bus drivers, merchant ship pilots, and train operators should be screened for obstructive sleep apnea. This is a step in the right direction, but what about the rest of the population?

It’s been estimated that 24% of middle aged men and 9% of women have at least mild sleep apnea. This is one of the most often cited statistics from 1993. I would think that with the obesity epidemic, the numbers are now much higher. A recent study looking at active independent seniors (ages 71-87) showed that 55% had significant sleep apnea. These numbers are much higher for seniors that are hospitalized.

You don’t have to be a commercial pilot, truck or bus driver to be at risk for sleep apnea. Everyone is at risk. If you have untreated sleep apnea, you are over 6 times more likely to get into an accident. Your reaction times are worse than being legally drunk. Snoring alone alone without sleep apnea also increased your risk by 300%.

Truckers will argue that most commercial accidents are caused by passenger vehicles. All it takes is one sleepy passenger car driver to cause a major bus accident.

Interestingly, another study showed that snoring men with daytime sleepiness or witnessed apneas drive more than others. It’s a scary thought. What they’re probably doing is to choose an activity where sustained vigilance is needed, but unintentionally, they are placing themselves and others at increased risk.

I admit that there are logistical and financial implications to putting into place a universal screening program for sleep apnea. Besides the costs alone, what do we do with people who can’t drive the bus or work at all while waiting to be cleared? What about all the people who can’t tolerate any of the treatment options? Do they go on disability? Do they have to switch to other careers?

On the other hand, the potential benefits are enormous. Treating the remaining 90% of undiagnosed sleep apnea patients will significantly lower the cost of providing healthcare since it’ll prevent or significantly lessen the severity of many medical conditions such as hypertension, diabetes, obesity and cardiovascular disease.

Given all these issues, what do you think about universal screening? Please respond with your comments in the box below.

Written by Steven Park · Filed Under Blog, obstructive sleep apnea | 8 Comments