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Mandatory Sleep Apnea Screening for Everyone?
Come over to my bog and join the discussion about mandatory screening for sleep apnea. It's an interesting discussion.
http://doctorstevenpark.com/mandatory-sleep-apnea-screening-for-eve...
Steven Y. Park, M.D.
http://doctorstevenpark.com/mandatory-sleep-apnea-screening-for-eve...
Steven Y. Park, M.D.
Views: 56
Replies to This Discussion
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Permalink Reply by Jerri Lynn on
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I read the article and I'm sorry but if you're referring to national mandatory screening of every American......The topic isn't worthy of discussion.......where do you draw the line!
Mandatory everything......for goodness sake! Drop it!
I'm sure more accidents and deaths are caused by drugs and alcohol!
If there's mandatory screening for sleep apnea, then there are millions of others who shouldn't be driving, flying or operating machinery either.............anyone with high blood pressure, high cholesterol, heart disease because they're at higher risk for stroke, heart attack etc.......you gotta be real here! The list can go on and on and on..........
The concept and thought of mandatory screening for sleep apnea is ridiculous!
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Permalink Reply by Mike on
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that's all well and good, Jerri Lynn, but how do you really feel?! ;-)
Jerri Lynn said:I read the article and I'm sorry but if you're referring to national mandatory screening of every American......The topic isn't worthy of discussion.......where do you draw the line!
Mandatory everything......for goodness sake! Drop it!
I'm sure more accidents and deaths are caused by drugs and alcohol!
If there's mandatory screening for sleep apnea, then there are millions of others who shouldn't be driving, flying or operating machinery either.............anyone with high blood pressure, high cholesterol, heart disease because they're at higher risk for stroke, heart attack etc.......you gotta be real here! The list can go on and on and on..........
The concept and thought of mandatory screening for sleep apnea is ridiculous!
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Permalink Reply by Henning on
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With regard to screening for OSA, I can say that there is a development in the Scandinavian countries, where each primary physician can do a screening for OSA.
This will be a small device which only measure a few points, but will give a much better basis to any further sleep apnea measurements.
This development is carried out in collaboration with various CPAP companies.
With the resources we all possess, we need new approaches.
Henning
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Permalink Reply by Steven Y. Park, MD on
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Jerry Lynn,
Realistically, universal screening's not going to happen, for the reasons you stated. It may literally bring our country to a halt. There are better ways of managing this all-to-common problem.
Maybe a better proposal is to strongly encourage doctors and employers to routinely ask a few simple questions to screen for those at highest risk. I don't know if they still do, but I'm told that in Iceland, they screen all school-aged children for sleep apnea.
Notice how the NTSB "recommended" screening for all the major transportation workers. What I wanted to point out was that screening for sleep apnea in our pilots is a good idea, but there will be ethical, logistical and financial consequences to any such "mandate."
But just for the sake of argument, since we routinely screen infants for PKU (1/15,000 incidence), congenital hypothyroidism (1/4,000), and galactosemia (1/200,000), why don't we screen for obstructive sleep apnea (~1/4 in men and 1/10 in women)? The yield on a sleep apnea screen is probably much more cost effective than screening for prostate cancer (about 1/1000 men) using PSA. Your chance of dying from sleep apnea (and its' complications) is probably much higher than dying from prostate cancer.
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Perhaps the biggest problem is to convince the doctors about this.
I have not forgotten when I mentioned the possibility of sleep apnea with my former doctor, he just laughed at me.
Today I have obviously a doctor who knows a lot about sleep apnea, and take it seriously.
Henning
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Permalink Reply by Tim on
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Yes, infants are automatically tested for some things and children going to public schools are required to get immunizations, are screened for various things in the course of going to school, and jocks have to get a physical before participating in sports. After somebody exits the public school system, the government loses this control..
Unless it is a condition for obtaining a license, it is impossible for the government to require mandatory testing for any medical condition. Aircraft and ship pilots, train engineers, and CDL license holders are relatively easy to require to get sleep apnea screening; it is going to be much more difficult to require other individuals to be screened for sleep apnea.
All state issued driver's license requirements are up to each individual state. It is going to be very difficult to convince voters that they have to get sleep apnea screening in order to get a driver's license. Many states don't require ANY testing for license renewals, and those states will have an even more difficult time requiring sleep apnea screening. . Even if periodic sleep apnea screening is required to get a driver's license, there is a certain percentage of the population that doesn't have a driver's license.
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Thanks for your reply Dr. Park. As a HR director, it's illegal to ask employment applicants any health related questions until after you've made an offer of employment. You can make the offer of employment contingent on passing a physical exam and drug testing but the examining physician is unable to disclose medical information to the perspective employer. The physician can only state to the perspective employer whether or not the individual is medically cleared and physically fit to perform the duties and functions of the job description(s). I suppose in the case of pilots, OTR careers, bus drives, trainmasters, etc., sleep studies may be appropriate. My brother is a career pilot; 20 yrs F-16 and 10 yrs for a major int'l overnight delivery firm. I'm now curious as to his perspective on this topic.
I agree that screening for sleep disorders should be part of every annual physical but physicans have to be educated first and foremost. Unfortunately, I believe there are still scores of PCP's that aren't trained and educated in this field.
Steven Y. Park, MD said:Jerry Lynn,
Realistically, universal screening's not going to happen, for the reasons you stated. It may literally bring our country to a halt. There are better ways of managing this all-to-common problem.
Maybe a better proposal is to strongly encourage doctors and employers to routinely ask a few simple questions to screen for those at highest risk. I don't know if they still do, but I'm told that in Iceland, they screen all school-aged children for sleep apnea.
Notice how the NTSB "recommended" screening for all the major transportation workers. What I wanted to point out was that screening for sleep apnea in our pilots is a good idea, but there will be ethical, logistical and financial consequences to any such "mandate."
But just for the sake of argument, since we routinely screen infants for PKU (1/15,000 incidence), congenital hypothyroidism (1/4,000), and galactosemia (1/200,000), why don't we screen for obstructive sleep apnea (~1/4 in men and 1/10 in women)? The yield on a sleep apnea screen is probably much more cost effective than screening for prostate cancer (about 1/1000 men) using PSA. Your chance of dying from sleep apnea (and its' complications) is probably much higher than dying from prostate cancer.
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Permalink Reply by susan mccord on
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Besides, if apnea screening is mandatory, and people are diagnosed +, is someone gonna mandate treatment? And who's gonna monitor THAT? The apnea police?????????????????
With all the patients we know about who refuse treatment, or can't tolerate CPAP, what are they gonna do with all the ridiculous amount of info they're gonna have on everyone? And/or, what's gonna happen to health insurance costs if everyone has to be
#1., screened and #2., treated??? Even a diagnosis will raise premiums.
Sounds like a bad idea to me.............
Susan McCord
Tim said:Yes, infants are automatically tested for some things and children going to public schools are required to get immunizations, are screened for various things in the course of going to school, and jocks have to get a physical before participating in sports. After somebody exits the public school system, the government loses this control..
Unless it is a condition for obtaining a license, it is impossible for the government to require mandatory testing for any medical condition. Aircraft and ship pilots, train engineers, and CDL license holders are relatively easy to require to get sleep apnea screening; it is going to be much more difficult to require other individuals to be screened for sleep apnea.
All state issued driver's license requirements are up to each individual state. It is going to be very difficult to convince voters that they have to get sleep apnea screening in order to get a driver's license. Many states don't require ANY testing for license renewals, and those states will have an even more difficult time requiring sleep apnea screening. . Even if periodic sleep apnea screening is required to get a driver's license, there is a certain percentage of the population that doesn't have a driver's license.
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Permalink Reply by RockRpsgt on
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I think that if they make it mandatory through the DMV is the only way to make it work. The insurance companies and PCPs would become the apnea police. No compliance no license. License suspension for this infraction should and will have swift punishments for violations. it is going to happen in the trucking industry soon. Swift and Schneider trucking already require drivers to be compliant or they lose their jobs. Insurance companies have no trouble not backing anyone for anything if they do not follow the guidelines.As long as they implement the process in pieces it will not meet very much fight. Divide and conquer.
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Right now there is no law in place requiring anything for truckers. It is in the works though. Had it not been for the economy troubles I believe it would have already happened. Insurance companies are offering discounts to the companies that comply.
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susan mccord said:Besides, if apnea screening is mandatory, and people are diagnosed +, is someone gonna mandate treatment? And who's gonna monitor THAT? The apnea police?????????????????
For pilots, the FAA could make a requirement that the flight surgeon (who issues the medical certificate) would have to certify that the pilot is compliant with CPAP before the medical certificate is issued. This is already done with other conditions, it wouldn't be a big issue to add sleep apnea to the regs. I suspect that train engineers also have similar medical certifications. I believe that compliance is being monitored for those truck drivers who are required to be compliant.
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