Encouraging OSA Testing and Awareness Among Physicians

William Noah, MD

Patients with obstructive sleep apnea (OSA) that had better long term-adherence with positive airway pressure (PAP) therapy machines received them through an integrated sleep practice (ISP) in comparison to those who received it from traditional durable medical equipment suppliers (DMEs), data from a recent study suggest.

Researchers found that the ISP group had a 71% (n = 1296) rate of PAP adherence at 30 days, a 66% (n = 1212) rate at 90 days, and a 52% (n = 961) rate at 1 year. These rates were significantly higher than those in the DME group, which had a 66% (n = 1327) rate of adherence at 30 days (P = .004), a 56% (n = 1116) rate at 90 days (P <.00001), and a 33% (n = 665) rate of adherence at 1 year (P <.00001). The ISP group also had a significantly duration of PAP use, with 357 minutes compared to 345 in the DME group at 30 days (P = .002), 348 compared to 319 at 90 days (P <.00001) and 312 compared to 164 at 1 year (P <.00001).

NeurologyLive spoke with study co-author William Noah, MD, director and founder, Sleep Centers of Middle Tennessee, to learn more about what prompted the study. He discussed his hopes that the study could help provide rationale to adjust Medicare legislation.

NeurologyLive: Should physicians try to raise awareness about sleep apnea and encourage testing?

William Noah, MD: Absolutely, and with home testing, it's become so easy. In 2020, we released a new program called OSAinHome. We've sort of equated the mortality and prevalence of OSA to hypercholesterolemia. With our OSAinHome program, we have made sleep testing and starting cPAP as fast and as convenient as a lipid profile. For 95% of patients, excluding patients on oxygen which we don’t do home testing for, the test is shipped out to them, and they get it in 2 days. The data uploads to the cloud so we have it the next morning. Over telemedicine, we go over the results of their sleep study. A sleep expert determines a diagnosis or if they need further testing and goes over their other issues related to their OSA—hypertension, diabetes, heart disease and equate it to those diseases so they can understand these issues should improve. Then, if it’s appropriate, they get a continuous PAP [cPAP] ordered and delivered to their house and the setup’s done virtually.

In 5 to 7 days, we can take a person from the referral and have them on cPAP. After that they go into our monitoring program, which is what really made the success in the study between the 2 groups. Our respiratory therapists look at their data and walk them through this process for the next few months to establish adherence. 

What prompted the study?

The American Academy of Sleep Medicine has been trying to get cPAP removed from Stark Law, which is what keeps us from providing cPAP to Medicare patients. This study should be the evidence to support getting rid of that. We had 4000 consecutive patients in the same practice receiving the same care. You can see that those who got their cPAP from this ISP had 50% better adherence. The Stark Law, which prevents the ISP from providing cPAP is disadvantaging Medicare patients. This is causing Medicare patients to have more diabetes, or hypertension, to not feel their best, worsening dementia, worsening mood disorders and more cardiovascular events. So, this law is hurting our Medicare eligible population in America. This is pretty strong evidence of that. It's just common sense. Do you want a respiratory therapist managing your cPAP for a 3-month period, or do you want a board-certified sleep physician overseeing a team managing your cPAP for the rest of your life?

Transcript edited for clarity.

REFERENCE

Andry JM, Tobin G, Shafin C, Noah W. Positive airway pressure therapy supplied by an integrated sleep practice associated with greater adherence among pre–Medicare-aged patients with sleep-disordered breathing. J Clin Sleep Med. 2021. 17(1):31-36. doi:10.5664/jcsm.8786