Dr Deepak Shrivastava, Prof., Dept of Pulmonary, Critical care & Sleep Medicine, University of California, talks to ETHealthworld about the different treatment options that have been developed for curing sleep apnea. Edited excerpts:
Tell us about the major complications faced by people suffering from sleep apnea?
Sleep apnea is one of the disorders which is probably very prevalent and has significant medical and social implications. It includes cardiovascular, neurocognitive as well as metabolic complications.
It is also associated with high blood pressure, cardiac arrhythmias, congestive heart failure, angina heart attack, sudden death, high blood glucose and stroke. These complications are implicated significantly because of uncontrolled, undiagnosed or untreated sleep apnea.
What are the ways to diagnose this disorder?
To diagnose sleep apnea, first order of the business is to screen and suspect that somebody may have sleep apnea. There are different studies that show that up to 25 percent of the men and 10 percent of the women can have obstructive sleep apnea at different levels. So it could be simple snoring to all the way to severe cases of sleep apnea.
Screening tools are very important and should be used in order to suspect the probability of this disorder. Subsequently there are testing to be done once the suspicion and high pre-test probability is there, either we offer home sleep testing or lab polysomnography.
Home sleep testing can be done in the comfort of the patients own home and in their natural environment. Certainly it has some advantages to do home sleep testing but it comes with the price of limited data acquisition compared to in lab testing which is very comprehensive.
What the different treatment modalities available for curing sleep apnea?
There are about 500 sleep labs at this time in India and I am sure given the large population of India we need many more sleep labs and home sleep test companies as well as sleep specialists.
New tools are becoming available once the diagnoses of sleep apnea is established, the treatment is needed and it can be provided in two forms -- one is the non renewable form which comes with a machine called Continuous positive airway pressure (CPAP). It is a small machine that provides pressure through a motor and pushes the air through the tube into the mouth or the nose in order to open the airway of the person. The idea of the surgery is to open the air space so that the patient can breathe. Its success rates are variable.
Surgical interventions can be done with mild sleep apnea especially if the patient is unable to be cured with the non-invasive therapy. The results at this time are approximately 50-60percent but it depends on the surgeon, their training and some of the patient characteristics. So these are the basic options to treatment that are available in addition to these other treatments or modalities are also available that should be practiced- For example; weight loss, smoke succession, refraining from drinking alcohol four hours before going to bed, good sleep habits and use of medications.
Sleep hygiene and sleep education is a very important part of patient management. When the sleep apnea is diagnosed and the treatment is initiated, patient still needs a lot of help and assistance and continuing to maintain the treatment because the default rate and non compliance with the use of the treatment is very high.