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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