Sleep disorders becoming an 'epidemic'
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Losing weight in conjunction with using CPAP can help, but drugs aren't very effective, said Aetna's Kropp, who also specializes in diagnosing sleep disorders. That's because sleep apnea is caused by airflow blocked by tissue that is too thick or loose or in the wrong spot.
"The fact that the obstruction is mechanical means most of the solutions are mechanical as opposed to pharmacological," Kropp said.
There also are surgical treatments, although many otolaryngolists who perform surgery, such as Baines, recommend CPAP first.
The most frequent surgical treatment, uvulopalatopharyngoplasty, or UPPP, involves removing soft tissue at the back of the throat and the uvula, as well as tonsils if the patient still has them. But the success rate is only about 50 percent, which is dismal, Baines said.
Among the new techniques she is using is a Pillar procedure, an implant of three small rods in the soft palette that cause it to stiffen and reduce or prevent blockages of the airway. Restore Medical, the St. Paul, Minn.-based developer of the implants, in November released the results of a one-year clinical study that showed they were a safe and effective treatment for mild-to-moderate obstructive sleep apnea.
But the Pillar procedure, which Restore said averages from $1,200 to $2,500 in the United States, is not covered by insurance. The CPAP device, which Snider said runs around $1,000, and some surgeries generally are covered.
Cigna's Gelzer and Kropp said their companies would only pay for some types of surgery if CPAP first hasn't worked out. Kropp said Aetna wants patients first to exhaust all non-invasive methods of treatment, including oral appliances such as a mouthguard that holds the tongue forward during sleep.
Is it worth the cost? A study by the American Association of Sleep Medicine released in November suggests it is. That study found that sleep apnea patients had an average of $260 in physician claims in the year before treatment; that figure dropped to $174 in the two years after diagnosis and treatment. Hospital stays fell from 1.27 days per patient per year before diagnosis to .53 days a year after diagnosis.
"We know we can reduce the amount of emergency room visits for heart failure patients if they have sleep apnea and are under proper treatment," Snider said. "
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