Israel's leading sleep medicine expert, Prof. Peretz Lavie, says the time is ripe for a major change in the way sleep medicine is practiced. Instead of beginning after the age of 50, as is the current practice, it should begin from the age of 25 or 30. This should particularly include people diagnosed with apnea, a condition in which sufferers momentarily stop breathing many times during sleep.
In a major article in the April 15 issue of the Journal of Clinical Sleep Medicine, (www.aasmnet.org/JCSM), Lavie of the Technion-Israel Institute of Technology's Rappaport School of Medicine explains that sleep apnea, most common in the overweight and obese, can lead to premature death from heart disease and stroke, but that this is preventible with early diagnosis and treatment.
Recently accumulated knowledge about the pathophysiology of cardiovascular diseases result from sleep apnea, he adds, requires significant changes to cope with a reorganization of the medical specialty.
He said that because of the shortage of sleep specialists and sleep clinics around the world and the gap between their numbers and the prevalence of sleep apnea in the general population, an alliance between sleep medicine and family practitioners is required.
In the US alone, some two million people are monitored with electrophysiological and electroencephalographic devices during sleep in nearly over 1,300 sleep clinics each year.
"This is undoubtedly explained by the growing awareness of obstructive sleep apnea syndrome and its profound impact on patientsâ€š quality of life and health," Lavie noted. Sleep apnea affects, in at least moderate form, one in 10 men and one in 25 women. For people over the age of 60 and in certain high-risk populations, such as obese people or habitual snorers, there are more people with breathing disorders during sleep than without.
Because of the importance of irregular breathing in sleep disorders, the majority of diagnostic sleep lab directors are pulmonologists (lung experts) rather than neurologists, psychiatrists and psychologists (including Lavie) who were in charge in the 1970s and 1980s.
If the patient is judged by the attending technician to suffer from breathing disorders during sleep that are above a threshold severity, the second half of the night is used to determine the appropriate air pressure for nasal continuous positive airway pressure (CPAP) treatment. This treatment, in which air is forced into the patient's lungs while sleeping, is prescribed for most patients with moderate to severe forms of breathing disorders during sleep. But Lavie noted that the standard one-night monitoring session is not enough, and evaluation of the results of CPAP is rarely done.
"A diagnosis of sleep apnea at the age of 50 may be delayed by 10 to 20 years from the time patients first display breathing disorders in sleep. This delay may be crucial because, during that time, there is an accumulated damage to the cardiovascular system," Lavie writes. "To prevent this damage, the diagnosis and treatment of breathing disorders in sleep should be done at the earliest age possible. Thus, there is an urgent need to lower the age of diagnosis from age 50 to between 25 and 30."
Family doctors must be trained in the essentials of sleep medicine, particularly in sleep apnea and in its treatment, he concludes, and to identify people with a high likelihood of having sleep-disordered breathing. He also notes that sleep medicine studies must be boosted in medical schools, which typically devote only a few hours to the subject during doctorsâ€š medical educations.
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