Sleep apnea is often dismissed as a non-serious condition

An article recently published in the Journal of the American Medical Association reported on a study that showed elderly women (mean age 82) who had sleep apnea were more likely to develop cognitive deficits than a similar group of women who did not have sleep apnea.  The study followed these women over a period of several years.  Although this study received a lot of press, the finding – one of the problems caused by sleep apnea is cognitive deficits – didn’t add much to the body of knowledge of sleep apnea.

Unfortunately, the most striking thing about this article is that this study has a major ethical problem.  It describes a clinical study in which patients were diagnosed with sleep apnea and were not treated for it; instead they were merely observed for several years to see what the effects of their disease were.  The principle has been long  established in the US that study patients must always receive the standard of care for their disorders under study, that is, they must be provided treatment if there is an approved one available.   This is the reason that placebo controlled studies are no longer done in multiple sclerosis for example.   Similarly, testing of new cancer drugs is done in combinations with approved therapies, so that the study patients are not denied available therapies.

This lapse in medical ethics is very troubling, but is likely an example of the general dismissal (by the public and health care professionals alike) of sleep apnea as a non-serious condition.  The net effect of this attitude is that many physicians still don’t consider screening patients who have obvious symptoms such as daytime sleepiness, snoring, or migraine headaches.  The list of health problems that are caused by or compounded by untreated sleep apnea is long and growing. Overnight polysomnography (sleep study) as a diagnostic tool, can be one of the most cost-effective solutions in health care today if providers will “wake up” to the real cost of untreated sleep disorders.

Elizabeth S. Rowe is senior scientific advisor to the MidAmerica Neuroscience Research Foundation.

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  • Rob Lindeman

    Very misleading title to this article.  Perhaps you derived the title from Ms. Rowe’s awkward syntax in the first sentence of the last paragraph.  In any case, a more accurate title would read “Sleep apnea is often dismissed as a NON-serious condition”.

    For what it’s worth, I disagree with the author as to the ethic of the study in question.  The study would be unethical if the natural history of OSA were well-described.  I don’t believe this was the case.  The IRB that approved the study must not have thought so either.

    • kevinmd

      Thanks for catching that. I edited accordingly.


  • kumud

    Could you cite the specific study? I think it’s as irresponsible and unethical to criticize a study without a citation, as it is to withhold established standard-of-care treatment a la tuskegee, which you allege was done here.

    And I don’t think sleep apnea is so much dismissed as non-serious, as it is accepted as a condition with little acceptable treatment options for patients.  Most patients i’ve come across who get bipap or cpap hate it, and eventually refuse to either use it, or lose weight.  And you cite sleep studies as the panacea for sleep apnea, but just making a diagnosis is way way short of “one of the most cost-effective solutions”…

    So really, should everyone with “migraines” have a sleep study? Sorry, from an primary care MD with a background in biostatistics, i respectfully disagree with the premise.

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