Tuesday, August 29, 2017

Do you know if you have sleep apnea? An eye exam may tell you

Sleep apnea is a lot more common than you might think, and it is affecting your eyes and vision in drastic ways. August happens to be National Eye Exam Month and this is as good of a reason as any to go get checked out.
There are three types of sleep apnea, but most people suffer from Obstructive Sleep Apnea (OSA), which makes up 84 percent of sleep apnea cases.

To find out why that matters, let’s layout a quick biology overview:

Our bodies need oxygen – we inhale it, our lungs hold it, our blood picks it up from the lungs and takes it to all of our cells and tissues. Every organ needs it. The brain, for instance, uses 25 percent of your oxygen intake. Without enough, your brain function declines.
OSA occurs when the soft tissue of the throat collapses and blocks the airway. It happens continually throughout the sleep cycle.
The blocked airway means you aren’t inhaling enough oxygen for your blood to carry throughout your body (decreased blood oxygen). The pause in breathing—called an apnea—can last anywhere from seconds to minutes. The brain then signals the body to wake up and breathe.
OSA is most common in overweight or obese men. It occurs in approximately 24 percent of men and 9 percent of women. African Americans also have a 2.5 times higher risk.
  • Other factors that may predispose us to this condition include:
    • Age – over 40
    • Smoking
    • Neck circumference over 19 inches (Trivia: OSA occurs in 34 percent of NFL linemen!)
  • Some of the most common signs and symptoms include:
    • Snoring – although not everyone who snores has sleep apnea
    • Daytime sleepiness – do you nod off at work; maybe it isn’t that you are just bored?
    • Cognition problems – losing your train of thought sporadically
    • Restless sleep – do you toss and turn a lot?
    • Loved ones mention you seem to stop breathing in your sleep

Despite its relatively high rate of occurrence, OSA goes undiagnosed in 80 percent of the men and 90 percent of the women who suffer from the condition. High rates of undiagnosed patients may be due to the fact that the best test—a sleep study—is both inconvenient and can be expensive for patients.

Sleep Apnea and the eye

An association of OSA and eye and vision problems is very common and often missed during any type of eye exam or physician visit. At your next eye exam, consider if you have any of these symptoms and share them with your provider. You may help them catch something they otherwise might miss!

There are three common eye-related OSA side effects to watch for:
  • Floppy eyelid syndrome – this is the most common and the easiest to miss during your eye exam. The person often wakes with scratchy or irritated eye(s) and some mucus discharge (some people refer to it as crusty eyes) that comes and goes over a long period of time. Close to 100 percent of people with floppy eyelid syndrome have some form of OSA.
  • Keratoconus – the person experiences irregular astigmatism and chronic blurred vision that glasses only partially correct.
  • Glaucoma – everyone should be tested for glaucoma. Its association to OSA is often missed. If a provider suspects someone has glaucoma, and also has any risk factors for OSA, they should consider further screening.

OSA is not harmless – get checked.

OSA is not a benign condition; as such, be aware of this condition especially if you have any of the common risk factors. This condition is a lot more common than you think and will take its toll if not treated. Since OSA so often goes unrecognized and misdiagnosed, mention any of the common signs and symptoms to your eye doctor and your family doctor. 

Special thanks to EyeQuest Vision Director Dr. John Davis for contributing this post!

Friday, August 18, 2017

Friday Federal Roundup: CBO, CHIP, and More

As a partner to states and the largest Medicaid / CHIP dental benefits administrator in the country, we at DentaQuest must stay updated on the latest health care policy trends - in large part because anything in the health space affects the oral health space.

Recent federal health reform proposals could have significant implications for Medicaid programs, exchange populations, and oral health coverage for low-income families. We keep our employees apprised of the latest happenings in Washington D.C. with weekly federal newsletters, and thought this week was particularly relevant for more than our staff.

Here’s this week’s newsletter.

CBO Releases Report on Subsidies 

According to a report released earlier this week by the non-partisan Congressional Budget Office (CBO), insurance premiums for ACA plans would rise 20 percent next year and in some areas of the country, people would not have any insurance options if the Trump administration scraps key ACA subsidies. Trump has repeatedly threatened to pull the ACA subsidies, particularly since Congress failed to pass repeal and replacement legislation before the summer recess. CBO’s analysis also found that eliminating the payments would increase the federal deficit by $194 billion over a decade because of higher spending on premiums subsidies. Trump must decide by early next week whether or not to make next month’s payment.

Congress Turns Attention to CHIP

Funding for the Children’s Health Insurance Program (CHIP) expires September 30th. With Congress out on recess, this leaves few legislative working days to ensure that nearly 9 million children maintain their medical and dental coverage. While CHIP reauthorization has historically been a bipartisan issue through the years, the hotly-contested debates over ACA repeal and replacement have left state officials anxiously awaiting assurances from Capitol Hill that 2017 will be no different. We will continue to monitor federal discussions on the future of CHIP and advocate where possible for the vital inclusion of dental coverage in reauthorization efforts.

Trump Administration Encouraging Medicaid Redesign Efforts, State Innovation

As Congress takes a pause on repeal and replacement efforts while they are on recess, states are looking to the Trump administration in the interim for more regulatory flexibility. CMS is expected to soon approve a Medicaid waiver from Kentucky which among other things would require most Medicaid-eligible adults to work as a condition of receiving coverage. Arizona, Arkansas, Indiana, and Maine are considering similar work requirements. HHS Secretary Tom Price and CMS Director Seema Verma have both expressed that they are in favor of such Medicaid redesign proposals.

Last month Alaska became the first state to get increased flexibility from the administration to prop up its individual marketplace with a reinsurance program. Minnesota, New Hampshire, Oklahoma, and Oregon are some other states that have already filed or are considering similar waiver proposals to submit to CMS.

HHS Proposes to End Obama-era Payment Programs

HHS Secretary Price has announced plans to eliminate two Obama-era Medicare bundled payment programs and scale back on a third. This proposal would cancel initiatives that make hospitals more accountable for the cost of certain joint replacement surgeries and cardiac care, and shrink an existing program covering hip and knee surgeries. This is considered a victory for providers who oppose requirements to participate in new payment models. We will continue to monitor whether or not HHS will take further action to roll back requirements in order to slow down the transition to value-based reimbursement structures.