Cardio Sleep Review

Dedicated to the Nexus of Cardiology and Sleep Apnea Management

Issue 2,

Home Testing Provides Cardiologists Quick Answers to Sleep Issues and Why That’s Critical

by Omar Burschtin, MD

The Mount Sinai Integrative Sleep Center in New York City has established a unique program to provide cardiologists with a quick and efficient way of diagnosing sleep apnea for their patients especially those with arrhythmias. In this Q&A, Dr. Omar Burschtin, sleep specialist and Medical Director of the Sleep Program, speaks with Cardio Sleep Review about the need for such a program and how it has become highly successful in a short time.

Omar Burschtin, MD
Omar Burschtin, MD

CSR: Your sleep clinic devotes Wednesday mornings to cardiac patients with suspected sleep disorders. When did you start this program and why?

Dr. Burschtin: While the degree of consequences of mild sleep apnea on health outcomes is still debatable, we know that moderate to severe sleep apnea has a significant impact on certain medical conditions and many of them are in the cardiovascular spectrum of diseases. As a sleep doctor, I have a special interest in taking care of those patients with cardiac arrhythmias, including atrial fibrillation, TIA, and strokes. We are here to help prevent those conditions from occurring or recurring by making sure these patients are treated adequately, quickly, and efficiently.

Sleep apnea is a common comorbidity to AFib, which affects about 2.7 to 6.1 million patients in the U.S. alone. The treatment for their atrial fibrillation is often cardioversion (electrical or chemical) or ablation. As a cardiologist, you might suspect your patient has sleep apnea, but you don’t have two or three months to wait for your patient to undergo sleep testing and another few weeks for you to get the results. We wanted to be able to get answers for cardiologists sooner before they performed the cardioversion or ablation. So, a little more than a year ago, we set up a program where we devote Wednesday mornings to cardiology patients who need sleep testing. We know that managing AFib patients with obstructive sleep apnea greatly improves outcomes and patient care. If they have sleep apnea and are treated, it reduces the chance of their having recurring arrhythmias after their treatment.

We see as many patients as we can schedule into the Wednesday morning program. If they’re appropriate candidates and we can get the insurance approvals, we send them home with the WatchPAT® for sleep testing that night. Patients then return the device themselves the next day or have someone bring it in for them. We review the results and send a report to their cardiologists that day. We started the Wednesday mornings with a vision to provide an immediate point-of-care and try to resolve a vacuum of the presence of sleep medicine in cardiac care.

CSR: Why has there traditionally been a delay in testing cardiac patients for sleep apnea?

Dr. Burschtin: Often the patients and their doctors don’t see getting to the bottom of their sleep disorder as urgent. There are multiple reasons for this related to family, distance, nursing homes, that make coming to a sleep center difficult for them, if not impossible. Or maybe they can physically, but they are elderly and they refuse. If they meet the criteria, we can do home sleep testing and that allows us to get the answers we need right away. Home sleep testing with WatchPAT® is easy for the patients and the results are reliable.

CSR: Are cardiologists aware of the need for sleep testing in their patients?

Dr. Burschtin: I think that cardiologists are pretty aware. The problem is not so much awareness. The problem is as a cardiologist you don’t think it’s fair to delay your patient’s treatment five months until he can get a consultation, testing, scoring, and therapy for his sleep issues. That’s why we started our Wednesday morning program and our team approach.

There are things that need to be done in a few days if you want to be efficient and responsible. That’s why I think the development of a team that makes sure there is no vacuum in any element of that multidisciplinary approach to the study of patients is critical. There are some 90 sleep disorders and our sleep program takes care of all of them. We see some with more frequency than others, but sleep apnea is the majority of them – the bread and butter we take care of on a daily basis.

CSR. Which patients are candidates for home sleep testing?

Dr. Burschtin: Essentially, we follow the recommendations of the American Academy of Sleep Medicine for home testing versus attended polysomnography (PSG). If the patient is a candidate for home testing, then we do home testing. If we’re looking for someone who is a NOVEMBER 2018 CARDIO SLEEP REVIEW 21 minutes for a new one. So, it’s whatever we can fit in the morning. If the patient from cardiology isn’t available on Wednesday morning, they can come any other day. And once I see them on a Wednesday and we make a diagnosis and start with therapy, they can come for follow-up any other day. I’m trying to preserve the Wednesday morning for new patients where they need this immediate approach. If I do a follow-up on a Wednesday, I don’t have space for a new one.

CSR: What makes your sleep center and your Wednesday morning program so successful?

Dr. Burschtin: I think the success of a program is a formula I have: experience plus knowledge multiplied by attitude. That’s my formula for success. Lots of people have good experience and knowledge. It’s the attitude that differentiates us. You need to have the right attitude to modify the way you do things to become excellent. The cardiologists we work with—and they are from across the Mount Sinai network and elsewhere— appreciate that we have a comprehensive program that will deliver the answers they need in a timely fashion. They know they can count on us. I think this service is the right approach. We take care of our patients from A-to-Z. Their home testing results come directly to us and we provide the interpretation. We recommend the patient begin auto CPAP when it’s indicated and send them for a sleep center study if it’s needed. The severity of the sleep apnea is not a contraindication for using auto-CPAP. There is some difference of opinion but there is nothing in the American Academy of Sleep Medicine that says for sleep apnea you cannot use CPAP.

CSR: How have you grown the sleep center program and why?

Dr. Burschtin: Before I arrived from NYU, there was one full time sleep doctor plus a half—so 1.5 FTE. Now this fall a new junior doctor is coming. She was our fellow last year. With her, we will have eight sleep doctors plus one physician’s assistant. That tells you we’re putting a lot of resources into supporting the needs of the community and that we also have a very strong research program and education program. We do about 13 sleep studies a day at our center Monday to Friday and most (about 10) are at-home. Our research is ongoing. The areas of research here are very wide. Right now, we’re doing more research in terms of central sleep apnea and its consequences. The need for sleep studies is on the rise because of many factors including obesity, hypertension, diabetes, and kidney disease. Cardiologists are becoming more aware of sleep apnea’s role in treating cardiac conditions. And as we grow the sleep program, we will have an opportunity to interact with other departments in the hospital and take it to the next level.

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Cardio Sleep Review
Publisher: Itamar Medical
Editor: Melih Alvo

The Cardio Sleep Review editorial team thanks all those who contributed to this publication.

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