Does Dr. Park Overdiagnose Sleep Apnea?

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?

Please note: I reserve the right to delete comments that are offensive or off-topic.

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4 thoughts on “Does Dr. Park Overdiagnose Sleep Apnea?

  1. My Sleep Dr. looks at me befuddled when I explain my fatigue issues, yet I only have less than 5 apneas per hour. I have an developed lower jaw, which is being treated by a DNA appliance. Thank goodness I’ve found Dr. Park’s site!

  2. of course I completely agree with you. what you can say in response to these people is that at the place where sleep medicine was born, Stanford University, the doctors and sleep techs there will acknowledge that likely ALL humans have sleep apnea. Stanford, similar to your experience, is accused of never getting a negative sleep study, as if they are overdiagnosing OSA. When it seems clear, from multiple studies that have come out recently, that their testing methods and criteria are simply superior to anywhere else.

    until we can shift perception in society about sleep disordered breathing, most people will continue to look at us askance. but we know that it is simply that they don’t yet see the brilliance of your paradigm. they cannot see the connections that seem so clear to us. we need to just keep going forwards. society can only grow as fast as its slowest members. someday we will get through to them all.

  3. One of the reasons you are so busy diagnosing OSA is because so many are needing to be diagnosed.

    Doctors are often reluctant to call for a sleep test due to cost and the fact that they often need to be re-done due to first night effect or personal variability.

    So, I have a suggestion:

    Build – Sleep Lab in a Box!

    Currently sleep testing is in lab, expensive, often inaccurate.

    Currently titration is done in a sleep lab.

    I think this would work better:

    We make this a government sponsored development project. This gets rid of the current start up capital issues and crazy stunted development due to proprietary secrecy issues.

    Basically – take all of the sensors and make them usable by the person in his home. Should take less space than my desktop computer.

    The person would come in for a couple of weeks of classes to learn how to put on, take off, use, and maintain the equipment. Practice would be done under the supervision of the instructor and/or helpers. At the end of this set of classes he would leave with the suitcase the little box was in.

    The sleep testing portion would take several nights to get a base – or – the titration portion would start if the persons OSA was so bad that to wait longer would be medically unwise.

    Titration / acclimation should be done over the next three to six weeks.

    Then the kind of general use machine can be determined, additional classes scheduled if needed, and the person brings back the “Sleep Lab in a Box” to exchange for is daily PAP.

    The daily PAP would be connected by the cell phone network or Internet to a data analysis center. The persons data would be available to him over the web for lifestyle management feedback. The data would also be automatically parsed and e-mails or calls would be made to the person and his doctor if problems arise.

    Very very slow titration would be done regularly to follow the persons actual pressure needs. Perhaps half a cm/H2O change checked for ten or so days – determine direction – move again if deemed wise.

    Once the initial development was done the boxes would be mass produced – low cost.

    The boxes would be reusable.

    The overhead of building and staff would be considerably less.

    I hope we do find a way!

    Tod Merley

  4. Well, naturally those of us reading you don’t feel that way. As someone with an AHI of 5, who has been accumulating fatigue for years, who has most of the cluster of symptoms you describe in your book, I’m glad that you are out there fighting for increased awareness of this common, chronic problem. I think now is the time when medicine is starting to recognize health issues like gluten/dairy intolerance, chronic stress, and mild sleep-disordered breathing that don’t present with any clear acute symptoms, but destroy people over decades. And you’ve got an important, unique, new piece of that puzzle. Keep on spreading the word, and the science will catch up.