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Did Dr Oz and Dr Breus miss the diagnosis of sleep apnea in a woman with insomnia on national television?
Yes, I suspect they did. I believe that that the woman has OSA and the diagnosis was missed. She should have a repeat study in another sleep lab and be given a sedative hypnotic to make certain that she sleeps. It is almost certain that this second study will reveal OSA requiring a PAP machine for effective treatment. The show was so bad that I am speechless (and typeless too).
Views: 134
Replies to This Discussion
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Permalink Reply by Linda Mix on
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I thought the same thing. I made me think badly of the sleep study lab.
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Permalink Reply by Steven Y. Park, MD on
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My feeling is that most cases of chronic insomnia is caused by or aggravated by an underlying sleep-breathing disorder, whether or not it's obstructive sleep apnea. Most people with insomnia have upper airway resistance syndrome, which is not usually picked up on most sleep studies. Many people with chronic insomnia also go on years later to develop sleep apnea.
If you look at the upper airway anatomy of insomniacs while on their backs, they have the typical narrowing of the posterior airway space. You'll also see that most chronic insomniacs prefer not to sleep on their backs (because their tongues are more prone to collapse when supine). Ask ten chronic insomniacs if their parents snore and 8/10 will tell you that one or both parents snore heavily.
Also wanted to point out that the above doesn't apply to acute insomnia. Everyone has insomnia at some point in their lives. It's incredible that I got as far as I did with so little sleep just before my SAT, MCAT, MSLE, and otolaryngology board exams :) But then again, I may have sleep-breathing problems as well.
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Permalink Reply by Mack D Jones, MD, SAAN on
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The show aired today. I don't see a link to it yet. I agree with Dr Park regarding chronic insomnia. I'd bet on mixed OSA and/or UARS (at the Stanford sleep lab, I was found to have both UARS and OSA after two false negative tests back home).
A little known fact is the high rate of false negative PSGs in accredited sleep labs (15 to 25% in one study a few years ago).
Nasal pressure monitors are supposed to pick up UARS when a Pes monitor is not being used, but in the real world, I wonder if they actually accomplish that.
Since Asians have a 24% incidence of OSA, Dr Park might want to consider a sleep study on himself just to play it safe.
Mike said:when did this show air? do you have a link to the summary/ video?
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I had a sleep study a while ago which was completely unremarkable, except for a few alpha intrusions. It was using nasal pressure monitors.
I do agree that Asians are more susceptible to sleep-breathing problems since they have smaller jaws. This is why Asians are much more prone to snoring, diabetes and hypertension, especially when they abandon their native diets and start eating a SAD diet (Standard American Diet).
My feeling is that under certain conditions, EVERYONE has some degree of sleep-breathing problems. Simple colds, allergies, pregnancy, and menopause can all cause nose and throat inflammation that can cause temporary or more chronic problems breathing at night. Simply having a stuffy nose can aggravate underlying sleep apnea. This is why I do everything possible to avoid nasal packs after any kink of nasal surgery. As you move up this continuum, you'll move above the threshold that's called obstructive sleep apnea.
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Permalink Reply by Mike on
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it's always seemed like a continuum to me -- one of my first impressions when i learned about cpap and what it does is that almost everyone could benefit from using a CPAP. what do you guys think of this analogy: someone who suffers from heart problems must eat a diet low in saturated fat, but even folks who don't suffer from heart problems should eat a diet low in saturated fat. likewise, someone who has diagnosed severe OSA must use a CPAP, but even those of us who don't have diagnosed OSA should use a CPAP. I know this is a radical proposition and I'm not necessarily endorsing it. Just throwing it out there for debate because I'm not sure how far from the truth it actually is. . .
Steven Y. Park, MD said:I had a sleep study a while ago which was completely unremarkable, except for a few alpha intrusions. It was using nasal pressure monitors.
I do agree that Asians are more susceptible to sleep-breathing problems since they have smaller jaws. This is why Asians are much more prone to snoring, diabetes and hypertension, especially when they abandon their native diets and start eating a SAD diet (Standard American Diet).
My feeling is that under certain conditions, EVERYONE has some degree of sleep-breathing problems. Simple colds, allergies, pregnancy, and menopause can all cause nose and throat inflammation that can cause temporary or more chronic problems breathing at night. Simply having a stuffy nose can aggravate underlying sleep apnea. This is why I do everything possible to avoid nasal packs after any kink of nasal surgery. As you move up this continuum, you'll move above the threshold that's called obstructive sleep apnea.
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To my knowledge, there have been no long term sleep studies on large numbers of people to determine the normal function of the upper airway. For all we know, the "normal" population may very well have hypopneas and apneas from time to time depending of the circumstances as Dr Park suggests. These would not be picked up on random sleep test. If that is the case, what are the consequences of these occasional apneas? Obviously they should be prevented if they have negative consequences.
You cannot justify PAP therapy if there are no apneas, hypopneas or UARSs. The problem is that a random sleep study is not likely to answer the question. You would have to have a nightly check on your sleep status to truly know where you stand.
It may very well turn out that Mike is right, that everyone would be better off on a PAP machine to prevent those apneas that may occur every once in a while. I can hardly wait for studies to clear up some of these questions.
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Permalink Reply by sleepycarol on
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Interesting concept. I had never thought in terms of the general population. I know when I was pregnant and as the baby grew, the more difficult it was to sleep at night. Now I wonder if it impacted my breathing any.
I do know that if I could go back in time, I would insist on a sleep study much, much earlier than when I finally had one.
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Me too. I had migraine headaches starting at about 9 years old. I suspect that as a child I had OSA as the trigger or underlying cause of those debilitating headaches (a genetic predisposition being a contributing factor).
If I could go back in time, I would have had my sleep status monitored from the moment I popped out of my mother's womb.
sleepycarol said:Interesting concept. I had never thought in terms of the general population. I know when I was pregnant and as the baby grew, the more difficult it was to sleep at night. Now I wonder if it impacted my breathing any.
I do know that if I could go back in time, I would insist on a sleep study much, much earlier than when I finally had one.
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I teach school and I was surprised at the number of kids that have migraines, although they are a minority -- there are still more than I imagined. Our school population is around 250 and probably 10 or so of those have been diagnosed with migraines.
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I vaguely recall a recent study in which a number of ~12 to ~19 year olds had headache, mostly migraine, and they all had OSA. It got my attention, because of my own experience. I think all youngsters with headache should be examined for OSA and when positive, treated with PAP.
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I am filing this away in the stuff I try to educate parents about. I am going to suggest that our school health aide come on here and read some of the posts dealing with kids. You never know when you may have the opportunity to bring it up to parents.
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