: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez
Saul Marquez: [00:00:18] Welcome back once again to the outcomes rocket podcast where we chat with today’s most successful and inspiring healthcare leaders. I really thank you for tuning in again today and by you to go to outcomesrocket.health/reviews. The most orating in review let us know what you thought about today’s podcast. Our guest. His name is Charlie Whelan. He’s the director of consulting for frost and Sullivan’s Healthcare Group out of San Antonio Texas. Has done his fair share in health care for almost two decades at Frost and he’s really passionate about a lot of subjects in health care but in particular very passionate about OSA obstructive sleep apnea. And so what we’re going to do today on this episode is focus on the work that they’ve done in this area. But before we dive into the content I just wanted to open up the floor for Charlie to give us a little bit more about him and then we could dive into what we’re going to talk about today. Charlie welcome to the podcast.
Charlie Whelan: [00:01:23] Thanks Saul. Thanks for having me. I appreciate it. So as you mentioned I’m with Frost and Sullivan we’re global market research and consulting company with offices all around the world and we spend most of our time working with industries that are developing new technologies helping them to evaluate the market opportunity for those technologies and the impact on them. Over the last four five years we’ve had the opportunity to work with a significant number of companies developing new technologies in the sleep marketplace. Most of those are focused on obstructive sleep apnea or central sleep apnoea. And we’ve developed a significant body of knowledge about that topic. Last year we had the privilege of doing two commissioned papers for the American Academy of Sleep Medicine where we surveyed 506 people who were treating their sleep. These are people are diagnosed as obstructive sleep apnea and decided to treat that condition. And we asked them what life was like before they started treating it and what life was like after they started treating them. So that was one white paper the other white paper that we did is we actually reviewed more than a hundred studies on the financial impact of obstructive sleep apnea. And combine that with the survey results to quantify for the first time really what the effect is economically when the United States under treats obstructive sleep apnea. It’s a huge problem.
Saul Marquez: [00:03:02] For sure and we had a chance to connect before this podcast Charlie and you are sharing some of the numbers the statistics how many people have it. How bad is it bad how poorly is it misdiagnosed can you run into some of those numbers. I was surprised.
Charlie Whelan: [00:03:18] Yeah I’ll go through some of those. So we estimate there’s probably about 30 million Americans with obstructive sleep apnea today. There’s two there’s two types of sleep apnea others destructive sleep apnea and that’s when your airway your throat your your tongue your nose basically collapses in on itself while you’re sleeping. The other type of central sleep apnoea and I describe it to folks that that’s basically your brain forgets how to sleep. There are some people with mixed sleep apnea. Most people have obstructive sleep apnea and we’re talking that a lot of that is being driven by the obesity epidemic in our country. But some of it is also related to the aging demographics that we have in this country that are associated with that. A lot of it has to do with weight gain. So that 30 million people that have obstructive sleep apnea we think somewhere between 80 to 85 percent of those people are undiagnosed today. A lot of those have mild to moderate symptoms. But there are still many many people out there probably millions of people with severe sleep apnoea that are not being treated for that condition. We think somewhere on the order of about 6 million Americans actually have sleep apnea and most of those are being treated usually with positive airway pressure or C sheens. But there are other treatments for it such as oral appliances which can hold the mouth forward to open up the airway. Some surgery can be beneficial for certain patients and then there are of course lifestyle treatments too that can be beneficial such as positioning yourself better while you sleep. But it’s a huge economic problem as well.
Saul Marquez: [00:04:58] Yeah. Charlie the numbers are pretty staggering that so many cases go on diagnose then these reports are pretty interesting. Not like the artwork on the cover it’s a picture of the both of them actually a picture of a very upset wife or girlfriend just covering her ears. And as husband snores away and she can’t sleep. And it could be the other way too right Charlie.
Charlie Whelan: [00:05:23] Absolutely. Now we believe that most people with obstructive sleep apnoea is disproportionately male. Men have stickered next man sticker and next contribute to more obstructive sleep apnea. We are seen again with the obesity epidemic. A more and more women with the condition as well. So it is a serious problem for both sexes and to your point on the cover artwork it’s kind of funny but in our research we actually found that people’s interpersonal relationships with their bed partners family members employers actually improved significantly once they started getting their sleep apnea treated and under control. And that we were actually able to quantify some of that. So you know you might actually be saving your marriage by treating your sleep apnea listeners.
Saul Marquez: [00:06:13] There you have it. If you are maybe snoring a little too much if you’re male snoring a little too much it might mean you get checked out. You might have OSA potentially save your marriage. There is one of those things that does matter. I was. And you said co-workers too. I was traveling with a co-worker and it was early in my career we had to share a room and let me tell this guy was just snoring his lungs off and I just couldn’t sleep. And it made it made it tough. That whole whole week that I was at that project with him and it just it was hard. So I totally believe it. Charlie What would you say some of the barriers to diagnosing and treating OSA are.
Charlie Whelan: [00:06:53] Well there are a couple of them. If we start with the patients themselves the first thing is is recognizing the symptoms of the condition. It’s commonly said that snoring is the same as sleep apnea. It’s actually not sleep apnea is when people stop breathing intermittently while they’re sleeping which is not quite the same thing as snoring. However the two are often hand in hand. So if you’re a heavy snore there is a good chance that you’ve also got some of the same risk factors for sleep apnea as well. Daytime sleepiness is another big predictor for that. And then also you look at your body mass index you look at your age you look at your neck circumference if it’s over 17 inches in color. There’s a good chance that you might be at risk for that as well. And they look at other code morbidity as well too so if you’ve got diabetes if you’ve got heart problems these might be indicators that you need to look into it and get it identified. So simply awareness is a big challenge. And then one of the other barriers to treatment is the current approach towards diagnosing the condition is pretty cumbersome. So 85 percent of cases we have a health care system that requires people suspected of obstructive sleep apnea to spend one and possibly two nights overnight doing a polysomnogram. It’s an expensive test. It’s a supplement it’s uncomfortable it’s no fun and it requires people to actually wear a cpap machine during the test as well as electrode leads and other types of things that make a really miserable and uncomfortable. So people don’t want to go through that. They say well maybe I have this condition I’ll learn to live with it. So that’s a big barrier is there we’re not at home. There is. So there is a home sleep testing technology. It doesn’t Major all of the same parameters as a in clinic poly somno sonogram and we are in an interesting point in the sleep industry where clinicians payers are debating about whether in clinic test is absolutely necessary for everybody suspected of sleep. Can we test somebody at home is that good enough to begin treatments. I’m of the opinion that it’s for many people and that we ought to be much more aggressive about using home sleep testing and auto pap technologies to get more people on treatment sooner and easier.
Saul Marquez: [00:09:26] Yeah for sure. That’s good to know that there’s already something there and maybe just somehow getting a broader interest in getting some of those tests to people at home because to your point if this is one of the burdens that you’ve got to be at the hospital tonight it’s cumbersome. Why not just get that done at home so that you could start avoiding some of the issues that come with it.
Charlie Whelan: [00:09:50] So that’s one of the big barriers. And then once people have a diagnosis in most cases almost like 95 percent of the cases treatment is going to be a positive airway pressure mask a chapter where basically for the rest of your life. And that’s no fun. Nobody enjoys that idea. So there are a significant number of companies trying to make positive airway pressure either more comfortable tolerable or finding just Turnitin you know one of them is those all appliances that I mention which are under utilized in this country compared to other countries which use them much more. There’s a lot of interest in implantable neuro stimulators which could take the place of Pappe for some patients. Similarly those with central sleep apnoea. But there’s just a lot of interest and recognition that more than half of people diagnosed with Osa either start Papen fallot and don’t stick with it after three months or they never begin it in the first place. They get the bag gnosis doctor says hey use this pap stuff. They’re like no way. I’ll just live with the consequences because it is such a difficult therapy to to maintain. I will say that our research shows pretty equivocally that those patients who do stick with positive airway pressure are extremely happy with it and have recognized some significant health benefits and many many areas but they’re kind of the minority. And so the challenge is how do we get more people to tolerate this whatever therapy they choose to stick with. People need to start getting treated.
Saul Marquez: [00:11:22] Charlie I oftentimes think of you know just compliance to routine and just being able to add here adopt a clinical protocol. It really comes down to leverage and if the leverage for the patient is strong enough they’re going to follow through. I mean is this life or death or is it something with just smaller consequences that add up over time. Like can you go into some some of that and tell.
Charlie Whelan: [00:11:48] Yeah absolutely. So for many patients it can be life or death. So we know for a fact we have very strong clinical data that we reviewed that shows people who have untreated obstructive sleep apnea can have a much higher risk of mortality associated with cardiovascular disease diabetes. We asked. No this is not scientific but we asked those patients that we surveyed did they have some of those other health conditions and it was a very strong Kohm were Beddie correlations. So I was about half of these patients were diabetic and had hypertension and cardiovascular disease and they reported that their reception of HBO when sea levels in the case of diabetics sir or blood pressure for hypertensive all improved once they got the sleep apnea under control. So the other thing that this therapy has going for it is that people can see the benefits of self aware of it in quality of life. On day one. So if you can learn to live with the mask you can see the benefits starting on the next day and you can’t say the same thing for many other medical therapies. Right. You can’t say that if you’re on a blood pressure pill that you feel better the next day after your first blood pressure pill you just take it because you’re told to. This is a case where you can actually see the benefits very very quickly and then it’s just learning to adapt and live with that work it into your lifestyle.
Saul Marquez: [00:13:20] Let’s think society let’s think a broader US. Can you tell us a little bit about the economic burden of undiagnosed and untreated OSA.
Charlie Whelan: [00:13:30] Sure. So our research suggests that the costs associated with Osa are about 162 billion dollars a year. Only about 12 billion dollars is actually going towards diagnosing and treating people with the condition. About a hundred and fifty billion dollars is associated with not treating that condition. So it’s a significant impact. Yeah a little more than half of that. By our estimation is associated with lost productivity. So this could be one of two things it could be lower productivity at work or higher absenteeism. So what we did in our calculations is we actually found among the people that were employed that they actually once they got their sleep apnea under control that they gained they reported to us that they gained one point two hours of productivity every day at work. And so when you extrapolate that out across the tens of millions of Americans with undiagnosed untreated sleep apnea at one point two hours of productivity every day if they were actually being treated. The numbers are huge in terms of how they add up. Yes. The other thing that we’ve found is that people who get their sleep apnea under control had 40 percent fewer work related absences and you add that up is what all the benefits are significant. So productivity improvement was a big one. That’s a little bit of a soft cost. We’ve also looked at motor vehicle accidents which accounted for about 26 billion dollars of commercial and non-commercial accidents workplace accidents at about six billion dollars. And then about 30 billion dollars associated with some of the significant cold morbidity associated with the condition like hypertension heart disease diabetes asthma insomnia and mental health conditions like depression anxiety and mental health. We calculated that we could see significant savings associated with caring for those conditions if we actually were more aggressive about addressing sleep apnea as well.
Saul Marquez: [00:15:41] That is really interesting. I never even thought that this was such a big problem and when you think about it from a productivity standpoint it makes a lot of sense. I just know when I get a good amount of sleep I know that the next day it’s going to be way more productive and just thinking about those decisions that I make to get to bed earlier. But then folks with Osa they have to think about breathing better and sleeping better because of it and it makes sense. Charlie how about the different players in the market and sort of how this means economic impact to payers to employers to patients.
Charlie Whelan: [00:16:15] Yeah so we think getting this under control is going to be a net benefit for everybody. Obviously patients are good a benefit from a health perspective they get a benefit from an economic perspective too because they’re going to be able to get more done have more energy take more opportunities to grow themselves. Employers obviously will see a huge benefit from improved productivity gains fewer accidents as well and less will be called Cyber loafing where people are not really getting anything done they’re just sort of goofing off at work payers. We expect we’ll see a benefit as well. And that’s that’s an area where there have been some resistance to covering more people with sleep apnea for that condition. So for example one of the things that’s happened over the last five or 10 years is that payers have required that clinicians demonstrate that patients are compliant for about three months on their pap machines before the payers are willing to pay for those pap machines. And while that is it is a challenging task to meet. I think it does make sense. The payers want to make sure that people are going to use this and the most progressive payers out there to recognize that this is a big challenge but they’re frustrated with the lower compliance as well. They want to see that proved. So I think things need to be done in terms of the delivery of care and the management of expectations for these patients to make sure that they’re screened earlier or diagnosed early or they’re more aggressively treated and that we are using a treatment approach that they can live with stick with so that everybody can win. I mean this is really a win win opportunity for everyone in my opinion.
Saul Marquez: [00:17:55] For sure. You know it’s so interesting Charlie when when you think of health and the implications of behavior on health it’s hard. I mean when you’re really wanting to manage people’s behaviors and what they do that’s tough. I wonder what can be done from an environmental perspective either in the home educational videos that kind of thing to help sort of nudge people toward that.
Charlie Whelan: [00:18:22] I think that probably has the biggest impact simply on screening and increasing awareness. So letting people know that their sleep is important that if they have symptoms that they don’t just learn to live with it which is the common thing that we all do. I mean we’ve all been sleepy we’ve all wished that we had more sleep but it’s hard to know when that is a serious problem when it is when it’s just a typical day when you did get a good night’s rest. So it is a little bit subjective. And I think patients could benefit from getting some more guidance on when they should be worried. And a lot of that has to do with looking at pretty well established risk factors associated with weight and age and other Kohm morbidity. And then maybe not relying so much on just subjectivity but there are pretty well established sleepiness scales and sleepiness tools that can be used in other kinds of risk assessments. I think that’s good. And in terms of getting improve compliance with actual treatments itself I think that that really has to come down to setting expectations getting better technologies and treatments out there for them to use. One thing I remind people is that sleep medicine as a discipline as a field is relatively young. It’s only maybe 40 50 years old opinion on who you ask. Even positive airway pressure as a treatment is relatively young. It’s a couple of decades old. So we’re still in the process we’re actually still exploring what the best treatments are and creating new approaches that can better serve individuals.
Saul Marquez: [00:19:57] And this is super insightful and so listeners. There is way more than we’ve covered here. We’ve come here to the end. But Charlie actually wants to share these two white papers with you. And so these white papers will be available at outcomesrocket.health/sleep SLEEP and so Charlie I’d love if you could just share some closing thoughts and the best place that the listeners could follow what you’re doing and what your partners are associated with this project are doing right.
Charlie Whelan: [00:20:30] So I would say stay tuned. There is a lot of activity both in terms of investment and professional activity and the sleep medicine space. Just this week a consumer electronics show there of course is always a big splash around New Sleep technologies. It’s going to be an important year for a number of major breakthroughs. I was reading just yesterday about a new sleep technology company that raised 50 million dollars in investment for their new technology. So it’s a really hot field of investment and innovation. It’s also an important area for research as well an investment. I like to tell people I think sleep is kind of like today where nutrition was 20 30 years ago. Back then we didn’t take what we eat as seriously as we do today we didn’t see the connections between what we ate and all of our other health outcomes. And I think we’re at the cusp where we’re starting to appreciate sleep in the same way and taking it much more seriously than we have in the past so it’s an exciting field to be in.
Saul Marquez: [00:21:32] Charlie this has been insightful again. Listeners go to outcomesrocket.health/sleep and you’ll be able to find those articles as well as more links that Charlie is going to share with you to dive into OSA further and what you can do to help yourself help those around you diagnose and also take care of it. So Charlie just want to say thank you once again for sharing your knowledge and looking for staying in touch.
Charlie Whelan: [00:21:58] Thanks, Saul.
: [00:22:02] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration and so much more.
The Best Way To Contact Charlie:
Linkedin – Charlie Whelan