Developments in Testing for, Treating Obstructive Sleep Apnea

The Holter apnea device is already available and distributed under the name of Life Screen Apnea^™ and the Holter oximeter will soon be available commercially, continued Dr. Stern. I do not know the price point yet, but it would be affordable and very cost-effective, probably five to 10 times less than a PSG. Right now, some insurance companies are covering the tests when submitted using the CPT code 95806.

GERD and OSA

According to the International Foundation for Functional Gastrointestinal Disorders, approximately 21% of the US population may suffer from gastroesophageal reflux disease (GERD); reflux appears to be prevalent in SDB patients.8 Some studies suggest that there is a correlation between OSA and GERD,9,10 as they share similar risk factors, as well as signs and symptoms, and that treating one condition often improves the other.11

In his presentation at COSM, The Impact of Treatment of Laryngopharyngeal Reflux on Obstructive Sleep Apnea/Hypopnea Syndrome, Michael Friedman, MD, Professor of Otolaryngology at Rush University Medical Center and Chairman of Otolaryngology at Advocate Illinois Masonic Medical Center in Chicago, stated that laryngopharyngeal reflux (LPR) is also extremely common in patients with OSA.

Reflux from GERD or LPR leads to nighttime arousals, which increase daytime somnolence, said Dr. Friedman. Repeated reflux often leads to tissue swelling, which may result in airway obstruction. Reflux may also cause vagal reflexes that bring about sleep apnea.

To determine whether treatment of LPR could improve OSA, Dr. Friedman reported on a prospective clinical trial in a tertiary care center that was done in two phases. In Phase I, 81 patients with signs and symptoms of OSA underwent a complete history and physical that included questions related to LPR and GERD symptoms, a PSG, a 24-hour wireless esophageal pH study, a snoring and Epworth Sleepiness Scale survey completed by both the patient and a family member, and a quality-of-life (QOL) survey.

We chose to use a wireless esophageal pH monitor rather than a transnasal pH catheter, which has to go down the patient’s nose and into the esophagus, causing greater discomfort, said Dr. Friedman. This new technology involves placing a sensor-about the size of a capsule-in the esophagus via endoscopy and attaching it to the esophagus with a small pin. The sensor transmits data, such as the frequency, duration, and degree of stomach acid reflux in the upper esophagus, to a collection device that the patient wears on a belt. Eventually the sensor dislodges and passes through the digestive tract. Most patients find that this procedure interferes less in their activities of daily living than using the catheter.