Should There Be a Global Approach to Sleep Medicine?

Global Care for Sleep Disorders: Toward Universal Access (B12)

9:15-11:15 a.m.


Room 7 A-B (Upper Level), San Diego Convention Center

Although the global burden of sleep disorders remains unknown, it is estimated that obstructive sleep apnea affects nearly 1 billion people worldwide—and that’s a conservative number, according to Atul Malhotra, MD, of the University of California at San Diego.

Dr. Malhotra will describe how researchers calculated that number as he introduces today’s session about global care for sleep disorders, chaired by members of the International Health Committee (Drs. Sonia Buist and Mihaela Teodorescu) and of the Assembly on Sleep and Respiratory Neurobiology (Drs. ChingLi Chai-Coezer and Bharati Prasad).

During this session, doctors from around the world (Georg Nilius, MD, Germany; Manuel Sanchez De La Torre, PhD, Spain; Yuksel Peker, MD, PhD, Turkey; Oana Claudia Deleanu, MD, Romania; Gustavo A. Moreira, MD, Brazil; and Sanjeev Sinha, MD, India) will discuss the models of care for sleep disorders/OSA used in their countries. Experts also will present the various methods used for diagnosing and treating sleep disorders/OSA, while exploring how a global standard could raise the level of care throughout the world if the sleep health service provision can be extended to reach under-resourced areas.

To address the growing problem of sleep disorders/OSA globally, increasing attention has turned toward the involvement of primary care physicians and specialist nurses for diagnosis and treatment.

“One-third of patients who visit their primary care physician have a high pre-test probability of OSA, yet the disease frequently remains undiagnosed and undertreated,” says Ching Li Chai-Coetzer, MBBS, PhD, of the Adelaide Institute for Sleep Health in Australia. “With the appropriate training of GPs and practice nurses, primary care-based management has significant potential to improve patient access to sleep service provision.”

In the past, OSA diagnosis rested on the performance of a full night attended polysomnography. Over the last decade, there has been increased interest in the use of home sleep apnea testing. Bringing ambulatory management into the treatment of OSA could make initial diagnosis less expensive and more attainable.

“Recent randomized trials have shown that in selected patients, HSAT can be just as effective as PSG as an initial test to diagnose patients with suspected obstructive sleep apnea, and likely should play a role in the management of selected patients,” says Najib Ayas, MD, MPH, of the University of British Columbia in Vancouver, Canada. “However, the use of HSAT varies considerably among and within countries.”

Another possible bridge for extending the reach of sleep services globally could lie in wearable technologies and telemedicine. Anita V. Shelgikar, MD, of the University of Michigan, says that cloud-based systems can provide new ways for patient and providers to collaboratively communicate in the management of chronic diseases, including sleep disorders.

“Patient-driven use of wearable devices, associated mobile apps, and cloud-based technologies can be used not only for individual patient care, but also for participation in crowdsourced research endeavors,” she says. “This may allow previously understudied populations to participate in research that may ultimately improve care for all patients.”

Even if these ideas guide sleep medicine toward a global approach, should this be a focus of sleep medicine? This team of experts offers arguments for and against having a global approach to sleep disorders. (See “The Pros and Cons of a Global Approach to Sleep Disorders” below.)

The Pros and Cons of a Global Approach to Sleep Disorders


Standardized approach will mean uniformity in international agreements for defining, diagnosing, and treating sleep disorders/OSA.

It would help to reduce diagnostic uncertainties and facilitate access.

Templates for formation of national guidelines could be provided based on international recommendations (similar to WHO recommendations with national interpretations and alterations).

It would foster acquiring evidence for developing appropriate resources for large data collection, funding issues, and homogeneity of methodology in publications.


Overall differences in population characteristics

Genetics: predisposition to development of sleep disorders, severity of damage caused, co-occurrence with other comorbidities, response to treatment.

Environmental factors: affecting baseline health status, risk factors for development of sleep disorders.

Cultural factors: readiness to seek health care, limited health care access for women, adherence to treatment, native and traditional medical practices.

Organization of health care: access; limitation in facilities for diagnosis and management, staff and expert availability; monitoring and follow-up limitations.