A new study suggesting that men and women are affected differently by sleep disorders could have a significant impact on the current Medical Benefits Scheme (MBS) review in relation to Medicare funding availability for sleep tests.
The research co-authored by Gold Coast-based ENT specialist and Bond University Associate Professor John Malouf and research associate, Allegra Boccabella, shows that women suffering from Obstructive Sleep Apnoea (OSA) are more likely than men to present with more severe symptoms of depression and trouble sleeping at night.
“Where men usually present with more obvious symptoms such as snoring, daytime sleepiness and a temporary suspension of breathing or ‘apnoea’ witnessed by their partner, women are more affected by the burdens of their symptoms,” said Dr Malouf.
“As such, they may present to their General Practitioner with issues such as depression, difficulty concentrating, forgetfulness or fatigue and general tiredness.”
Recently published in the American Academy of Sleep Medicine’s peer-reviewed Journal of Clinical Sleep Medicine, the research involved a retrospective clinical audit of 744 patients who received sleep-related healthcare from their GP. Patients completed a variety of sleep-related questionnaires including the Epworth Sleepiness Scale, the Snoring Severity Scale and the Functional Outcomes of Sleep Questionnaire 10.
“What was surprising about the results was that, while men and women tend to present at a similar age, their symptoms and the effect on their lives differed markedly,” said Dr Malouf.
In the MBS Review report currently under consideration by the Federal Government, changes have been recommended to the entry criteria for sleep studies, making them harder to obtain.
“The new criteria proposed by the Review panel is based on the more widely recognised ‘male’ symptoms,” said Dr Malouf.
“If these changes are legislated, women are far more likely to be excluded from being able to undergo a Medicare-funded sleep study.
“In a separate analysis, we applied the proposed new criteria to 2,000 consecutive patients and found that 1,700 would be automatically excluded from a Medicare-funded sleep test. Of those 1,700, more than half had moderate or severe OSA.
“What is of grave concern is that the new ‘male focused’ criteria, if legislated, would exclude 94% of women presenting to GPs for their sleep health from being able to access a Medicare rebated study.”
According to Dr Malouf, the irony of the new MBS-suggested criteria is that Medicare-funded sleep tests would be allowed for patients with obvious OSA symptoms who probably don’t need such a sophisticated and expensive test to diagnose the condition.
“It could be argued that these more complex tests should be reserved for a group whose diagnosis is more in doubt,” he said.
“If the government were prepared to rebate a lower level test for the obvious sufferers and be more analytical in their approach to funding more complex tests, good medicine and fiscal responsibility would be simultaneously preserved.”
A sufferer of OSA himself, Dr Malouf is the founder of SleepGP – a medical education provider that offers specialised sleep medicine training to GPs.
“Identifying potential OSA patients usually falls to GPs, based on a range of symptoms which could include seemingly unrelated issues such as insomnia and motor vehicle accidents.
“It is estimated that 1.5 million Australians suffer from sleep disorders, with a large proportion going undiagnosed.
“When you consider that almost 70% of stroke victims have OSA and that OSA sufferers are seven times more likely to have a car accident, it is critically important that we improve that diagnostic rate.
“Understanding that men and women are likely to present with different symptoms will help GPs identify female OSA sufferers even though they might not be snorers, have witnessed apnoeas or suffer from daytime sleepiness to the same degree.”