"To Sleep, Perchance to Dream......"

We send an inordinate number of our patients for clinical sleep studies, and many of them return with diagnoses of Obstructive Sleep Apnea, Restless Legs Syndrome, and occasionally more esoteric scientific labels of "disordered sleep". It is widely understood that individuals with morbid obesity often suffer from apnea---periods during sleep wherein respiration will temporarily cease---and a considerable cohort of our patients spend their nights tethered to machines which enable them to breathe normally during those hours set aside for nocturnal rest which most of us take for granted.

It came to my attention today that some cutting-edge and forward thinking diagnostic sleep centers are beginning to offer sleep studies in hotel rooms rather than the relatively sterile sleep labs generally located in hospitals and medical centers across the country.

Many of us have difficulty sleeping in strange places and foreign beds. If we knew we had a sleep disorder and were sent to a sleep center for diagnosis, why would we necessarily be comfortable enough in a laboratory to fall into a sleep pattern which mimics that which the technician would like to monitor and assess? Thus, a new marketing niche for sleep centers and hotels is born.

In Chicago and Cleveland, these hotel-hospital alliances seem to be thriving, and patients apparently appreciate the more cozy and private environments which can create sleep experiences more closely aligned with a patient's natural sleeping state.

So, is this type of "boutique" healthcare only for a select segment of the population? Who would be offered such a service? Who would be denied? Who would never be told it existed?

For those readers who already are acquainted with this writer's sociopolitical stance vis-a-vis the provision of equal healthcare for low-income populations, you will not be surprised that this trend of medical care does indeed raise a few red flags for me in a certain contextual framework.

Working with low-income Latinos on Medicaid in the inner city, I immediately wonder how many of our patients---if, of course, they met clinical criteria---would even be offered such a service. Our patients---most of whom have never been able to afford a single night in the most moderate of hotels---live in public housing, have little access to transportation, and certainly live as some of the poorest in the country, most well below the official level of poverty.

Consider for a moment the following scenario: Medicaid and, say, Blue Cross/Blue Shield will both agree to pay for a diagnostic stay in either the traditional hospital sleep lab or the hotel version. A provider in a sleep disorder clinic has a university professor with narcolepsy in exam room #1, and a disabled Latino woman with obstructive sleep apnea in exam room #2. Given that each patient meets clinical criteria for a stay in the new Marriott-based sleep center, and each insurance will reimburse at the same rate, which patient will be offered the opportunity for a night at the hotel-based clinic, and which will be relegated to the cinder-block sleep room at the hospital? It's a no-brainer, really, and my trusty "Healthcare Inequality Detector" (patent pending) reaches the red zone of the meter in no time.

Call me cynical, folks, but I have seen enough in the last ten years to know that our patients will often----but not always---be sent to the back of the healthcare bus, so to speak. I don't always mean to be a burster of bubbles (or do I?), but when I see a new specialty being offered that potentially smacks of elitism or classism, I somehow feel the need to point out the potentially inherent disparities which may be encountered therein. As I explore the new offerings of such services in our region (which are now beginning to manifest), this will be one aspect of such care that will certainly fall under my scrutiny (and that of my aforementioned Healthcare Inequality Meter).

So, in your wanderings and peregrinations, dear Reader, keep an eye out for such disparities, empower patients to receive the care they need, and champion the notion that even the poor deserve a good night's sleep at the Raddison (especially if Medicaid is paying the bill).