I’ve been working in respiratory and sleep medicine for more than ten years. Particularly for sleep apnea, it is quite a common disease in Hong Kong, but not many people are aware of it.
Doctors may suspect that patients are suffering from sleep apnea if they are obese. But we have seen from our own clinical practice that many of these patients are quite thin with BMIs less than 25. We also know that sleep apnea is related to vascular outcomes and also metabolic consequences, so I think early diagnosis is important but a constant hurdle.
A few years ago, we conducted a survey about the waiting time of polysomnography in our public hospitals. The median waiting time in Hong Kong is 75 weeks. I think this is an unsatisfactory condition. It leads to poor insights on our patients.
I think with the use of home sleep testing, patients can get an earlier diagnosis. In that case they can enhance their compliance to our medical advice—
whether that is weight loss, surgery, or use of a sleep app. Early diagnosis helps patients gain control of their disease management. It is a key reason for [the medical community] to do more research on home sleep testing.
Now with COVID-19, all in-patient sleep studies have been suspended for some time. Even though some services have restarted, patients are quite concerned about hygiene in a hospital setting. To get a diagnosis early and accurately for those worried about infectious disease, I think home sleep testing is the way to go.
One reason is that the patient is experiencing comorbidities—for example, young males with heart disease or hypertension.
Most of our colleagues are quite welcoming of home sleep testing, actually overjoyed. Firstly, there is no more need to ask patients to wait. It’s very difficult to explain to a patient who is suffering the need to wait for 75 weeks. Our colleagues receive referrals from endocrinologists, cardiologists for early sleep tests. For GPs, more seminars and educational opportunities to better understand early diagnosis and management of sleep apnea would be a good idea. Most patients GPs encounter have some sort of sleep problems.
I think quite a few devices are wellvalidated. There are published data on the accuracy of home sleep testing.
But this is the way that we are going, to expect devices that have less contact to the patient’s body, yet with improved accuracy. We also expect a few more parameters to help us to predict which patients are improving with a particular treatment (for example CPAP) or who is going to get a worse prognosis from, say, a cardiovascular point of view.
We are expecting more interesting and useful devices in the near future.