A good night sleep keeps the heart doctor away!
By Jennifer Cook,
Global Medical Director, Itamar Medical (Nasdaq:ITMR)
MD FAHA FACC
Dr. Cook is an attending physician in charge of the cardiovascular intensive care unit responsible for managing patients receiving mechanical circulatory support and extracorporeal membrane oxygenation at the University of Cincinnati. Previously, she was the associate professor, medical director, fellowship director and physician lead at the Banner University Medical Center at the University of Arizona. In this role, she revitalized the heart transplant program, increased patient volumes and improved outcomes in addition to a variety of other responsibilities. Prior to joining the University of Cincinnati, Dr. Cook was an associate professor and a medical director at the Medical University of South Carolina, where she developed the mechanical circulatory support (left ventricular assist) device program and served as principal investigator in multiple medical device and pharmaceutical clinical trials.
Dr. Cook earned her M.D. from Southern Illinois University. She completed her residency in Internal Medicine at the University of South Carolina and post-doctoral fellowships in Cardiovascular Disease and Advanced Heart Failure at Washington University in St. Louis.
Jennifer Cook, MD FAHA FACC
Global Medical Director, Itamar Medical (Nasdaq:ITMR)
Recently in the journal Sleep and Breathing, Pillar et al published a multi-center validation study showing that the WatchPAT™ home sleep apnea testing device reliably differentiates obstructive from central apnea events among heart failure patients. With this development, I am more excited than ever about the opportunity to care for patients who suffer from heart failure. The Centers for Disease Control reports that heart failure affects 5.7 million Americans with half of them expected to die within five years of diagnosis. It is also well known that heart failure patients with severe sleep apnea have higher mortality; one study suggesting average survival of only 2 years. Population studies reveal that nearly 80% of heart failure patients have sleep apnea; 50% with moderate to severe symptoms.
The classic subjective inquiry of heart failure patients includes assessment of their level of fatigue and quality of sleep. Often, they report difficulty breathing, especially when lying down at night. Fatigue is also a common complaint with limitations in physical exertion, often feeling tired and wiped out. When seeing patients in clinic as a heart failure specialist, my standard questioning frequently uncovered symptoms warranting diagnostic sleep study. It is surprising then that 80% of heart failure patients with sleep apnea remain undiagnosed and untreated, despite discussing sleep symptoms with their primary care physicians and cardiologists. What factors contribute to this epidemic of untreated sleep apnea? More importantly what can be done in 2020 to impact this important cardiovascular co-morbidity?
In the past sleep testing required an overnight stay in a laboratory while being directly observed by a sleep specialist. With only 5,000 Board Certified sleep physicians in the United States, long delays are common in securing a referral for sleep consultations. Although the emergence of home sleep apnea testing has facilitated improved patient access to diagnostic testing, this has yet to significantly impact patients with heart failure.
Unlike other home sleep studies that require complex set up that include nasal cannula, respiratory belts and other sensors, WatchPAT utilizes peripheral arterial tone signal. WatchPAT is comfortable for patients sleeping, simply requiring a sensor on their chest and finger and a watch on their wrist. The device can be issued to the patient by the clinic physician or prescribed through independent diagnostic testing facility such as BioTel Heart in certain states. The results of the sleep study are analyzed by proprietary algorithm that has been validated in statistically significant number of heart failure patients, providing a comprehensive report that is analyzed by a sleep physician.
The Watch PAT is well suited as a diagnostic tool for the cardiology patient and practice. The American Academy of Sleep Medicine (AASM) added peripheral arterial tone or PAT™ based technologies to their formal practice guidelines, an important step to reaching patients with heart failure and sleep apnea. Using WatchPAT as a diagnostic tool, access to therapy is only limited by the physician’s awareness and recognition of this important cardiovascular co-morbidity.
Assuming the role of Global Medical Director for Itamar Medical, I look forward to impacting practice patterns of cardiologists and heart failure specialists; especially now as device therapy is emerging as promising intervention for central sleep apnea.
