Panel to provide clinical pearls for managing sleep apnea

There are far more patients with sleep apnea—around 1 billion worldwide—than sleep medicine specialists can treat. It’s no surprise that a growing number of nonspecialists are seeing patients with sleep apnea, and they aren’t always familiar with current best practices and the common questions patients pose.

A panel of sleep apnea experts will address some of the most common questions and offer clinical pearls for both specialist and nonspecialist providers during the session Cases in Sleep Apnea That Keep You Up at Night today at 2:15 pm CT.

“Not everybody is taught the practical side of sleep apnea management in medical school or in residency,” said session chair Sara Pasha, MD, Assistant Professor of Pulmonary, Critical Care, and Sleep Medicine and Medical Director of the University of Kentucky Sleep Disorders Center. “There is a huge disconnect between a very common medical problem—sleep apnea—and the common troubleshooting clinicians need to do, and the lack of practical knowledge provided in internal medicine training.”

Dr. Pasha said the session will explore the four most common problems associated with sleep apnea:

• Persistently elevated apnea-hypopnea index
• Oxygen vs positive airway pressure
• Boosting patient adherence to continuous positive airway pressure (CPAP) treatment
• Patients who are sleepy during the day despite CPAP

“We will be talking about the common problems we see in patients who are using CPAP devices and the troubleshooting that can solve most of them,” Dr. Pasha said. “There are a lot of myths around CPAP and sleep apnea, but the reality is that CPAP can improve quality of life for a lot of people. It’s just a matter of dealing with the common issues.”

According to Dr. Pasha, CPAP has issues, but just as clinicians tend to underestimate the prevalence of sleep apnea, they tend to overestimate CPAP problems. The reality is that CPAP is so effective that in some studies, about 75% of users are adherent during the first 90 days. That compares with an estimated adherence of 50% for inhalers in patients with asthma and 40% to 60% for hypertensive medications.

“CPAP is one of the few therapies that tells you exactly how much it is being used,” Dr. Pasha explained. “The data are more limited for long-term use, but, in my experience, spending more time with patients and educating them on how and why to use CPAP is close to that 75% mark.”

CPAP adherence isn’t automatic, she said, but behavioral psychology can help.

Patients who are self-motivated, or appropriately guided by their provider, have a better understanding of how positive airway pressure can affect physical and mental health, as well as quality of life. Using CPAP regularly can improve blood pressure, cardiovascular health, diabetes, atrial fibrillation, sleep deprivation, daytime alertness, and other health issues. Patients who get the message are more likely to use their CPAP.

Patients who are not educated on the benefits, or who are disheartened easily by complications such as finding the right CPAP mask, are less likely to be adherent.

“I tend to give my patients a fairly long introduction on why CPAP is important and what untreated sleep apnea does,” she said. “And the secret I always share with them is that yes, there will be issues, but we will solve them together.”

Patients typically try three or four masks before they find the right one, Dr. Pasha continued. Improving adherence is as much about setting patient expectations as it is about setting CPAP device parameters.

“Sleep apnea is more common than most of us realize, and it is comorbid with most of the diseases we see in the hospital,” she added. “This session will give some basic troubleshooting on issues that come up when people start wearing their CPAP and will provide practical information that can be actively applied in daily practice.”