Who Should Care for Our Greatest Generation's Sleep Disorders?

At the 2004 Annual Meeting of the American Academy of Otolaryngology (ear, nose & throat) - Head and Neck Surgery Foundation in New York, Terence Davidson, an Ear Nose & Throat Surgeon (ENT) and Dean of Continuing Education at the University of California, San Diego, was invited to give a "mini seminar" entitled "Thinking of Opening a Sleep Lab?" Dr. Davidson could also be called the "father" of the current attempt to get Medicare to approve unattended home testing for sleep apnea. It was his Jan. 29, 2004 letter to the Centers for Medicare and Medicaid Services (CMS) that argued that the current policy is inhibiting the diagnosis of obstructive sleep apnea (OSA) because the nation's 692 sleep labs are simply too full.

Dr. Davidson claims that 95-99% of people with OSA can be diagnosed in the home and has prompted CMS to reassess its decision to require beneficiaries receiving continuous positive airway pressure (CPAP) to be diagnosed in a lab using polysomnography.

During Dr. Davidson's presentation in New York, he had some interesting opinions and comments and also seemed to have some conflicts of interest and an astounding degree of arrogance towards the Sleep Medicine and Pulmonary Medicine professions.

Although he has claimed to have no conflicts of interest, Dr. Davidson is on the Medical Advisory Board of Directors of ResMed, Inc. as a paid consultant. ResMed and their auto titration CPAP units stand to benefit substantially from gaining Medicare's approval of in-home, unattended testing.

He has staggering disrespect for Pulmonologists, some of whom are also on ResMed's Board, saying that "Sleep apnea is a disease of the upper respiratory tract, which doesn't have much to do with the lungs." He added that Pulmonologists view the upper respiratory tract as nothing more than a "nuisance" that stands between them and "something they can recognize." Adding, "We've all seen them pass by large neoplasms just to do their bronchoscopy," Dr. Davidson went on to say that "Sleep apnea is ours for the taking."