NetWorks: Uranium mining, hyperoxia, palliative care education, OSA impact

Occupational and Environmental Health Respiratory Care Palliative and End-of-Life Care Sleep Medicine

April 6, 2017 | CHEST Physician

Amanpreet Kaur, MD

Steering Committee Fellow-in-Training

David L. Bowton, MD, FCCP

Steering Committee Chair

Education in palliative medicine

Prompted by concerns that the Affordable Care Act would be instituting “death panels” as part of cost-containment measures, “Dying in America” (a 2015 report of the Institute of Medicine [IOM]) identified compassionate, affordable, and effective care for patients at the end of their lives as a “national priority” in American health care. The IOM identified the education of all primary care providers in the delivery of basic palliative care, specifically commenting that all clinicians who manage patients with serious, life-threatening illnesses should be “competent in basic palliative care” (IOM, The National Academies Press 2015).

Considerable effort has been put into providing clinicians with tools to gain this competence. Resources exist from organizations, ranging from the American Academy of Hospice and Palliative Medicine to the American College of Surgeons. Numerous publications address everything from symptom management to teaching communication skills to medical students and residents. But the question remains – can physicians who have been trained to “tread with care in matters of life and death” balance comfort with cure (Lasagna 1964, Modern Hippocratic Oath)? We believe the answer ultimately is yes, and that this balance may prove to be the antidote to the pervasive issues of burnout that plague our profession.

Check out our NetWork Storify page later this year for links to the ongoing discussion surrounding palliative care in medicine and for useful tools in the effort to provide palliative care to all our patients.

Laura Johnson, MD, FCCP

Steering Committee Vice Chair

The impact of sleep apnea: Why should we care?

With recent large trials such as the SAVE and the SERVE-HF studies challenging the cardiovascular benefits of treating sleep-disordered breathing in specific patient subsets, many physicians may start to question, “Why all the fuss?” The Sleep NetWork is bringing the leaders in the field to CHEST 2017 to discuss their take on where we stand with the connection between sleep-disordered breathing and cardiovascular disease, so stay tuned!

Meanwhile, we might reflect on the safety, social, and economic impacts of OSA and its treatment. Sleepiness due to OSA significantly affects driving performance and has received significant attention from the Federal Motor Carrier Safety Administration (FMCSA). Patients with OSA are six times more likely to have a motor vehicle crash than those without OSA (Terán-Santos et al. N Engl J Med. 1999;340[11]:847). One transportation company, Schneider, has incorporated an OSA screening and treatment program and reported a 73% reduction in preventable driving accidents.

Our relationships, general health, and work productivity can be affected by untreated OSA. The effect on daily life may not be initially obvious. Patients often present only at the insistence of their partner or physician, only to be surprised at how much better they feel once treated. Symptoms of OSA are associated with a higher rate of impaired work performance, sick leave, and divorce (Grunstein et al. Sleep. 1995;18[8]:635). A recent survey estimates an $86.9 billion loss of workplace productivity due to sleep apnea in 2015 (Frost & Sullivan. Hidden health crisis costing America billions. AASM; 2016. https://www.aasmnet.org/Resources/pdf/sleep-apnea-economic-crisis.pdf. Accessed March 21, 2017.). The same survey found that among those who are employed, treating OSA was associated with a decline in absences by 1.8 days per year and an increase in productivity 17.3% on average. Considering that the majority of OSA remains undiagnosed, this could have tremendous economic impact.

OSA is an important public health burden. The Sleep NetWork is committed to increasing awareness among individuals (patients and clinicians) and institutions (transportation agencies, government) of the impact of sleep-disordered breathing on society.

Aneesa Das, MD, FCCP

Steering Committee Chair