Japanese versus USA clinical services for sleep medicine

Abstract

In order to compare clinical services in sleep medicine in Japan and the USA, a survey was sent to sleep clinicians who were identified through the American Academy of Sleep Medicine (USA), the Japanese Society of Sleep Research (Japan), and other related sources (Japan). The survey assessed the number of available beds for polysomnography (PSG), the number of overnight PSGs and multiple sleep latency tests (MSLTs) performed, the percentage of PSGs used for diagnosing and evaluating sleep‐disordered breathing (SDB) patients, and the main treatment strategies for SDB. The number of beds in sleep centers/laboratories in the USA ranged from two to 12, and PSGs were performed on a daily basis (median number of PSGs per week: 20). However, 67.8% of Japanese sleep facilities did not have beds exclusively used for PSG, and they did occasional PSGs (median: three per month). Because there are a lot of facilities where they did not have beds for PSGs, PSGs were conducted in rooms that served a different purpose. Multiple sleep latency tests in the USA were performed on a weekly basis (i.e. 1–5/week), but were widely unavailable in Japan. On average, 79.4% of PSGs were used to diagnose or manage SDB in the USA. This was more variable in Japan. Nasal continuous positive airway pressure (nCPAP) was the first choice for therapy of most patients with SDB in the USA, while therapy in Japan depended more on the facilities available. A very small number of Japanese sleep facilities are used to conduct PSGs routinely, and fewer still are used for MSLTs. Therefore, most patients remain undiagnosed and untreated. In addition, in Japan, there is no regulatory consensus about the standards of sleep clinics and laboratories, or the requirements for diagnostic methodology or treatment strategies.

Sleep medicine in Saudi Arabia: Current problems and future challenges

“…[1430313435] The number of beds designated for sleep studies per 100,000 people was 0.06 in the KSA compared to 0.3–1.5 in developed countries. [14] Despite the limited number of beds for sleep studies, the overall occupancy rate was 45.7%.…”

Imbalance between the Reality of Sleep Specialists and the Demands of Society in Japan

“…However, PSG was never undergone routinely for the purpose of clinical diagnosis and treatment, as it was not covered by the national health insurance until 1990. Even after the coverage started, because nearly all prices are strictly controlled by a fee schedule, and direct co-pay to providers is forbidden, the more we performed PSG (PSG reimbursement: 33,000 JPY = 300 USD, Oct. 2004), the more we suffered to make ends meet 1) . On the other hand, at present, American physicians have, as a role model, full-time specialists working for sleep disorders centers, while Japanese physicians deal with some aspects of sleep disorders as a small part of a larger medical practice such as pulmonology, psychiatry, otolarygology, neurologiy, etc.…”

“…In response to this accident, the Ministry of Land, Infrastructure and Transport circulated a notification that every commercial driver should be checked for the presence of OSAHS under the responsibility of their business firms, although there was not a proper number of physicians who could see OSAHS nor clinics/hospitals where suspected people could consult 1) . At first there was some hope that this situation could be a trigger for developing sleep medicine in Japan, but later the bitter situation became obvious as little has been done for setting up a feasible system for meeting the demand.…”

“…1). Patients with sleep disorders in Japan have been seen by a few of the pulmonologists, psychiatrists, otolaryngologists with an emphasis on what they could see, doing occasional polysomnography (PSG)(median: 3/month) in clinics/ hospitals without beds exclusively used for PSG, while the number of beds in sleep centers/laboratories in the US ranged from 2 to 12, and PSGs were performed on a daily basis (median number of PSGs per week: 20) 1) . We may well say that sleep specialists with a comprehensive perspective and equipment are virtually non-existent in Japan.…”

Discrepancy in Polysomnography Scoring for a Patient with Obstructive Sleep Apnea Hypopnea Syndrome

“…PSG has been accepted as the "gold standard" for evaluating individuals with sleep disorders and the severity of these disorders. According to Tachibana's study, the estimated number of overnight PSG studies in Japan would be 18.3 PSG/ year per 100 000 people, and 60.9 ± 28.2% of PSGs were performed for sleep disordered breathing (Tachibana et al 2003). Since the Association for the Psychophysiological Study of Sleep established a standard system for visually scoring stages of sleep in 1967, this system has been known as the "Rechtschaffen and Kales standard" (Rechtschaffen and Kales 1968) and has been used worldwide.…”