By Annette M. Boyle
Because of their unique demographics, VA patients are four to five times more likely to suffer from sleep apnea than the general population.
They also have more options for treatment.
Dawn M. Bravata, M.D.
Veterans now have access to two new technologies to diagnosis and treat sleep apnea not yet adopted by the private sector. The first, an iPod-size testing device, allows veterans access to home-based sleep evaluation. The second, Provent, provides an option for treatment that many people with mild to moderate sleep apnea find less cumbersome and easier to use consistently than the traditional continuous positive airway pressure (CPAP) device.
“The Veterans Administration has really been a leader in sleep-disordered breathing research and treatment, and particularly in sleep apnea, which is its most common form,” Henry Klar Yaggi, MD, MPH, VA Connecticut Healthcare System and director of Sleep Medicine at Yale University School of Medicine told US Medicine.
The high prevalence of sleep apnea in veterans treated by VA is understandable, Yaggi said, explaining, “the VA predominately serves older men, many with obesity, so they have the three biggest risk factors.”
Research published this spring in Preventing Chronic Disease estimates that between one-third and nearly one-half of U.S. veterans are at high risk for sleep apnea.1
In the general population, 80% to 90% of people with sleep apnea are undiagnosed, according to estimates from the National Research Council.
Diagnosis and treatment of sleep apnea has a significant effect on overall health. The fatigue and daytime sleepiness commonly associated with sleep apnea may be the least serious of the condition’s consequences.
“Good prospective studies demonstrate that sleep apnea independently increases risk for heart disease, stroke, diabetes and all-cause mortality,” Yaggi explained. Researchers at the VA Palo Alto Health Care System in Texas are studying the association between sleep apnea and the rate of cognitive decline in older veterans.
Previous studies showed that CPAP usage attenuated the risk of diabetes and seems to improve neurological recovery from stroke. 2,3
“We’re now doing randomized, controlled trials to determine whether CPAP usage reduces risk of cardiovascular disease and other important outcomes,” Yaggi said.
To identify more veterans with the condition, the VA has embraced ambulatory, home-based sleep testing, which opens up access to evaluation to patients who may have limited mobility, transportation issues or simply prefer not to be tested in a sleep laboratory. The small unit “is an effective way to test, especially for those at high risk for sleep apnea,” said Yaggi. “It’s used throughout the VA along with sleep labs for sleep studies. But diagnosis is the easy part.”