A prime example: diagnosing and treating sleep apnea. The numbers of potential sleep apnea patients is enormous, and the impact to their health is undeniable.
Nitun Verma, M.D., MBA — a board-certified sleep medicine physician, spokesperson for the Academy of American Sleep Medicine, and director of sleep at AC Wellness — told HME Business, “Nearly 30 million adults in the U.S. have obstructive sleep apnea, a chronic disease that involves the repeated collapse of the upper airway during sleep, and many of them live undiagnosed.”
A 2019 study (“Estimation of the global prevalence and burden of obstructive sleep apnea: a literature-based analysis”) published in Lancet Respiratory Medicine further demonstrated the worldwide scope of the problem. The study estimated that 936 million adults around the world, aged 30 to 69 years, have mild to severe obstructive sleep apnea, with about 425 million having moderate to severe obstructive sleep apnea.
“The number of affected individuals was highest in China, followed by the USA, Brazil and India,” the study said.
Sleep apnea is often entangled with other serious conditions such as cardiovascular disease. A June 2021 study published by the American Heart Association said, “Obstructive sleep apnea occurs in 40% to 80% of people with cardiovascular disease, yet it is under-recognized and undertreated.” One of the study’s authors, Yerem Yeghiazarians, M.D., FAHA, professor of medicine in cardiology at the University of California, San Francisco, said at the time of publication, “Obstructive sleep apnea can negatively impact patients’ health and increase the risk of cardiovascular events and death. This statement is to encourage increased awareness, screening and treatment as appropriate for sleep apnea.”
The challenges to adherence
Despite the dangers of untreated sleep apnea, patient adherence to clinician-recommended sleep regimens remains an immense challenge.
“Adherence struggles to succeed for several predictable reasons,” said David Siegel, CEO of Nationwide Medical Inc., a provider of respiratory and sleep apnea solutions based in Calabasas, California. “With an increased transition to home sleep testing, we are seeing less personalized care and education at the diagnosing stage. This results in less buy-in from patients, causing weaker compliance rates when challenges arise.”
On the professional end, “Additionally, more real-time tools are needed for clinicians, but for that to happen improved reimbursement needs to be considered,” Siegel noted. “It is proven that treating sleep apnea lowers the overall cost to the health care industry, but we must spend the dollars up front to realize the long-term gains.”
Asked about the biggest challenges for the sleep apnea technology and equipment segment, Sam Talya, business category leader, therapy platforms, sleep & respiratory care, Philips Respironics, said, “Today, clinicians are faced with an obstructive sleep apnea patient population that is growing in both size and complexity, as 69% of care providers see more patients now than they did two years ago. Over a quarter of clinicians have indicated they do not have sufficient time needed to provide quality care for their patients.
“As a result, patients are experiencing shorter visits with health care providers, leaving less time to understand recommended obstructive sleep apnea treatments, which could potentially undermine adherence to therapy.”
Robust patient support from the start is critical, Talya added. “One of the most significant factors impacting adherence to sleep apnea treatment is relearning how to sleep comfortably with a PAP [positive airway pressure] mask. For many obstructive sleep apnea patients, wearing a mask may not come naturally, making support in developing this new sleep just as important as the mask’s fit and comfort. Because masks are not a one-size-fits-all solution, patients must take the time to select a mask that best aligns with their individual sleep style and facial characteristics.”
How lifestyle impacts adherence
More basic factors can also impact how well patients adhere to treatment recommendations.
“Patient lifestyle and habits play an important role in determining treatment outcomes for obstructive sleep apnea,” Verma said. “For example, if an individual uses CPAP [continuous positive airway pressure], but regularly gets less than the seven or more hours of recommended sleep each night, they might not experience better outcomes,” and might still notice symptoms such as daytime fatigue, weight gain and high blood pressure.
So, lessening the impact of sleep apnea can require more than just using sleep apnea systems properly.
“When it comes to sleep health, regardless of whether you have a sleep disease or not, establishing consistent, healthy habits is essential,” Verma said. “That means going to bed and waking up at the same time daily, getting the recommended duration of sleep based on age, and bringing sleep concerns to your health care professional when they arise.”
Comfort while trying to sleep is also critical.
“Effective obstructive sleep apnea treatment requires a properly fitted mask tailored to a patient’s unique needs, along with educational resources and support to encourage adherence to sleep therapy,” Talya said. “Mask comfort plays a crucial role in adherence, making it essential for manufacturers to consider factors such as facial fit and sleep behavior to better support patients at home. When a patient receives the personalization and ongoing support they need, they can sleep better and may experience fewer therapy-related challenges.”
Sleep apnea testing and treatment at home
Health care as a segment is increasingly leaning into at-home based care as a cost-effective model embraced by patients. How could this trend impact sleep apnea diagnosis and treatment?
“It is estimated that one billion people in the world live with obstructive sleep apnea, yet approximately 85% remain undiagnosed,” Talya said. “While these figures are staggering, innovations in remote patient monitoring and consumer wearables are beginning to help identify obstructive sleep apnea earlier. Consumer wearables, such as smart watches, now have FDA [U.S. Food & Drug Administration] clearance to collect health data on factors like respiratory rate and breathing disruptions, offering patients and their health care providers greater visibility into health care trends.
“Although confirmation with medical-grade devices is still required, these wearables can give clinicians a valuable baseline indication of potential health issues, such as obstructive sleep apnea. These insights can create an earlier entry point into a patient’s care journey, helping clinicians determine whether additional testing is warranted, and enabling more timely diagnoses, interventions and treatment decisions.”
“I believe the shift toward at-home care aligns almost perfectly with where sleep apnea diagnosis and management are headed,” Siegel said. “We are seeing a clear expansion of home sleep testing, and when you factor in cost and convenience for patients, it likely means the trend will only accelerate.
“Additionally, the scale and efficiency of home sleep testing results in faster and lower overall costs to the health care industry. Most people are already relying on objective data and analytics from wearables and/or smart devices they own.”
Verma agreed that greater access to at-home testing “may help ensure that individuals who otherwise don’t have access to screening or testing obtain important information about their sleep health.”
But Verma cautioned that at-home testing also has limitations. They “don’t capture all sleep stages, which means key data can be missed and therefore not included in the physicians’ analysis. For example, if there are a small amount of apneas, but the patient was awake for a large part of the night, that is a risk of a false negative test. They also leave room for error due to sensor or mechanical issues, because it is possible a sensor drifts for part of the night.”
Current limitations of at-home testing, Verma added, mean that other sleep disorders — including insomnia, restless leg syndrome or narcolepsy — won’t be captured.
“It’s important to emphasize that the scope of at-home sleep test is relatively limited, and should only be administered by a provider in a handful of scenarios,” Verma said, citing those concerns.
Funding’s influence on sleep apnea advancement
While the home health final rule released last November officially announced the Centers for Medicare & Medicaid Services’ (CMS) intention to restart Medicare competitive bidding for durable medical equipment, prosthetics, orthotics and supplies, so-called “legacy” product categories from previous bidding rounds won’t be included in the next round.
“The decision to exclude legacy products such as sleep apnea equipment from competitive bidding was the right decision for several important reasons,” Siegel said. “The most recent round of competitive bidding demonstrated that reimbursement rates had already reached unsustainable levels. When combined with rising labor, delivery and cost-of-goods expenses, further reimbursement reductions would have made it financially unviable for most providers to continue offering these services.”
Therefore, including competitive bidding in the next round “likely would have resulted in significant provider attrition and reduced patient access to care,” Siegel explained. “This risk of care disruption is a central concern and is already emerging in other product categories, such as continuous glucose monitors, where competitive bidding is currently scheduled to move forward. Ultimately, competitive bidding at reimbursement rates even lower than today’s rates threatens both provider viability and patient access to essential care.”
“As a widespread chronic disease, obstructive sleep apnea impacts many Americans, especially those with pre-existing health conditions such as high blood pressure and diabetes,” Verma said. “We should be increasing access to obstructive sleep apnea treatment and CPAP for vulnerable populations — not decreasing it.” Including sleep apnea systems in competitive bidding would “certainly impact individual health and put a strain on the American health system,” Verma added.
Creating brighter mornings for patients
Siegel said he believes the treatment of sleep apnea is at “an inflection point.”
“Beyond technology advances, the biggest shift underway is how sleep apnea is being valued in the broader health care ecosystem,” he explained. “Payers, employers and health systems are increasingly recognizing that untreated sleep apnea quietly drives up costs across all segments of industry. Today, patients are more informed, more engaged and more motivated by quality-of-life improvements than ever before. It is up to us to continue technological advancements, improve education, and reduce various frictions that currently exist in today’s care model. Those who adapt to this shift toward value, outcomes and patient experience will be best positioned to thrive in the future.”
Talya emphasized the need for rigorous patient support: “For patients who are new to PAP therapy, educational resources or support tools can play a critical role in easing the initial transition and sustaining long-term adherence. Educational content can help reassure patients that their therapy is working as intended and provide guidance when issues arise. In addition, dashboards can track a patient’s sleep progress, while coaching resources support goal setting and self-management, creating a more positive treatment experience that can strengthen adherence.”
Ultimately, Verma said, better outcomes will hinge on making treatment regimens more user friendly.
“The fundamental challenge is that sleep apnea treatment requires nightly commitment from a population that is already exhausted and overscheduled,” Verma said. “Making treatments easier to use will increase adoption. Innovation that minimizes nightly preparation time and reduces device maintenance will be critical to improving adherence.
“The most promising expansion will come from improved accessibility and user experience. As patients increasingly recognize sleep as foundational to overall health (not just a medical issue), they’re demanding treatments that fit seamlessly into their lives. Smaller, quieter, connected devices that feel less like medical equipment and more like wellness technology will drive adoption, particularly among patients who expect their health tools to be as intuitive as their other technology.”
Verma also suggested a more proactive approach for clinicians: “Education and awareness are the most important pieces. We have substantial research that proves the benefits of treating obstructive sleep apnea with CPAP in most cases, including practice guidelines from the American Academy of Sleep Medicine. As providers, it’s important that we regularly ask our patients about their sleep health, even if they aren’t diagnosed with obstructive sleep apnea. In diagnosed cases, we need to conduct regular follow-up visits with patients to discuss the treatment plan and symptom management, and use data to ensure adequate treatment and adherence. The more we can normalize and de-stigmatize obstructive sleep apnea, the better.”
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