Improving access to sleep apnea care through cardiology practice accreditation
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Patients with CVD are 40% to 80% more likely to have comorbid obstructive sleep apnea, which in severe cases can cause them to stop breathing hundreds of times a night.
Obstructive sleep apnea (OSA) is associated with myriad forms of CVD, including hypertension, HF, CAD, pulmonary hypertension, atrial fibrillation and stroke. Unfortunately, most cases of OSA in the U.S. are unrecognized and undiagnosed, meaning there is a strong likelihood your patients are impacted by this comorbid condition. It is critical to establish a multidisciplinary team approach to tackle this health care crisis and reduce the risk for CV death. Cardiologists are in a unique position to increase the screening and diagnosis of OSA, getting patients on a treatment pathway that can improve their overall health, well-being and quality of life.
A scientific statement published in June 2021 by the American Heart Association recommends screening for OSA in patients with resistant/poorly controlled hypertension, pulmonary hypertension and recurrent AF after cardioversion or ablation. To help cardiology practices identify OSA and improve patient access to sleep apnea care, the American Academy of Sleep Medicine (AASM) now offers a first-of-its-kind Specialty Practice Accreditation program for cardiology practices that evaluate and manage patients at high risk for sleep apnea.
The Specialty Practice Accreditation program was launched after a 5-year pilot program, which took place in a multisite cardiology practice. The program provides a new framework in which cardiologists and sleep specialists can work together to reduce the burden of undiagnosed sleep apnea while upholding the highest standards of care, solidifying critical patient access to treatment for OSA and helping to improve heart health. This initiative supports the AASM mission of advancing sleep care and enhancing sleep health to improve lives.
Sleep apnea as a risk factor for CVD
Untreated OSA costs the U.S. nearly $150 billion each year by increasing the risk for comorbid conditions, motor vehicle accidents, workplace accidents and lost productivity. Because many patients with CVD have comorbid OSA, it is of great benefit for cardiologists and sleep medicine specialists to form an interdisciplinary alliance to streamline and improve patient access to sleep care.
Research suggests that as little as one night of severe OSA can impair the body’s ability to regulate BP. Approximately 30% to 40% of individuals with high BP, and up to 85% of people with treatment-resistant hypertension, also have OSA.
Heart disease is the leading cause of hospitalization in Americans aged at least 65 years, but research shows middle-aged men with severe OSA are 58% more likely to develop HF. The risk for AF is two to four times higher among those with OSA, and patients with untreated, severe OSA are eight times more likely to fail AF treatment.
Considering the association between OSA and CVD, the cardiologist is presented with an opportunity to take a leadership role in identifying patients with sleep apnea by participating in their diagnosis and incorporating sleep physician colleagues in the sleep apnea management team.
An evolving landscape: Subspecialists embracing sleep
Compared with 20 years ago, physicians, including cardiologists, increasingly recognize that poor sleep and sleep apnea are frequent and serious problems among patients. Sleep is essential for optimal health, and especially heart health. Today, cardiologists understand that OSA should be approached as a chronic disease requiring long-term, multidisciplinary management and are looking for new ways to provide efficient, cost-effective and optimal patient care. Diagnosis of sleep apnea has become more accessible and cost-effective with the advancement of diagnostic testing at home along with more options for treatment of sleep apnea besides positive airway pressure (PAP) therapy.
In recent years, groups like the AASM, of which I am currently president, have continued to explore new strategies to advance sleep care by leveraging the expertise of other specialists, such as cardiologists.
In tandem with the support of board-certified sleep physicians and facilities, and using comprehensive practice standards established by the AASM, cardiologists are helping to reduce the physical and financial burdens of undiagnosed sleep apnea and, as a result, are saving lives.
Benefits of accredited specialty practices
Specialty Practice Accreditation will expand our reach as accredited sleep facilities collaborate with cardiologists to improve patient access to OSA care. To earn the new AASM Specialty Practice Accreditation, a cardiology practice must demonstrate that it screens patients for OSA and provides diagnostic home sleep apnea tests according to current AASM practice standards, including those for scoring, interpretation and diagnosis. The cardiology practice must also have an existing relationship with an accredited sleep facility that will provide full, in-lab sleep studies when needed, along with other guidance to ensure high-quality sleep care for our patients. Accredited specialty practices can then refer patients who require management of sleep apnea or another sleep disorder to a sleep facility for proper treatment and follow-up care.
Given the mounting evidence of the relationship between CVD and OSA, and the growing number of patients with CVD who have sleep disorders, it is essential for cardiologists and sleep specialists to work together to make screening for sleep disorders the standard of care. With 23 million undiagnosed cases of OSA, the sleep medicine community needs to collaborate with other care partners to get this chronic disease under control. Cardiology is the logical place to start, given the proven relationship between OSA and CVD. This, in turn, can serve as a model for future collaboration between sleep physicians and other medical specialists to provide the highest level of care and facilitate lifesaving diagnosis earlier in a patient’s disease state.
By encouraging cardiologists to incorporate screening and testing for sleep apnea into their practices, we can work together through a multidisciplinary approach to reduce the burden of undiagnosed sleep apnea and enhance both sleep health and heart health.
References:
- American Academy of Sleep Medicine. AASM announces new Specialty Practice Accreditation program. aasm.org/aasm-announces-new-specialty-practice-accreditation-program. Published Jan. 13, 2022. Accessed May 10, 2022.
- American Academy of Sleep Medicine. Hidden health crisis costing America billions. aasm.org/advocacy/initiatives/economic-impact-obstructive-sleep-apnea. Published Aug. 8, 2016. Accessed May 10, 2022.
- American Academy of Sleep Medicine. Specialty Practice Standards. Available at: aasm.org/wp-content/uploads/2021/11/AASM-Specialty-Practice-Standards-2022.pdf. Published Jan. 10, 2022. Accessed May 10, 2022.
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For more information:
Raman Malhotra, MD, FAASM, is the president of the American Academy of Sleep Medicine and is board-certified in sleep medicine and neurology by the American Board of Psychiatry and Neurology. He is a professor in the department of neurology at Washington University School of Medicine in St. Louis. He can be reached at rmalhotra@aasm.org; Twitter: @aasmorg.
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