Past, Present and Future of CPAP

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therapy. The search for a magic pill will go on, but they are still not yet on the horizon.

What is the current focus of your research for the treatment of sleep apnea?

I have several areas of active research. The first is in infant and childhood obstructed breathing. This area has been neglected compared to adult sleep medicine, yet sleep disordered breathing in childhood is probably very instrumental in delaying or damaging cognitive development. We have a number of projects designed to better identify these children at risk. The second area is sleep disordered breathing in pregnancy. We showed several years ago that women with pre-eclampsia develop obstructed breathing in the third trimester and that it triggers a large rise in arterial blood pressure in sleep. Nasal CPAP stops the obstruction and prevents the blood pressure rise. We have an on-going multi-center study to determine how many women snore in pregnancy and to determine if the onset of snoring in pregnancy induces hypertension and gestational diabetes. I am developing new methods of recording sleep disordered breathing that are more suitable for children and can be used both long term and in the subject’s own home.

Do you see any recent United States public policy/private payer decisions as having a particularly motivating or chilling effect on CPAP use?

I understand that reimbursement remains an issue. I am concerned that there is lack of services for children with sleep
disordered breathing, and I suspect that there are many children who have significant disease that goes untreated. I also know there is controversy over how and who should do sleep apnea studies. Many professionals object to the use of ambulatory at-home testing. While I share the concerns that patients might be treated without adequate medical evaluation, I do think simplified diagnostic methods do allow better access to diagnosis. I think the problem here is that the sleep centers should be taking the initiative and developing practice protocols that utilize these methods so they are better able to triage patients and identify the problem patients who need more complex investigation.

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