Waking up to a nighttime killer

The hope at home

Kong was referred to a respiratory specialist at Prince of Wales Hospital and advised to undergo a diagnostic sleep test, known as a polysomnography.

However, the average waiting time for the test at a public hospital in Hong Kong is 72 weeks. Doctors did not feel it was safe for Kong to wait that long, so in December, they recommended he perform a sleep test at home using a monitor called an Embletta.

When he did, the results were unsettling. The device recorded that he stopped breathing 58 times every hour, each time for at least 10 seconds. He was diagnosed with severe sleep apnea.

Prince of Wales Hospital is the only public hospital in the city that offers to lend machines to patients suspected of having sleep disorders, saving them the hassle of an overnight stay at its clinic. Hui, who introduced the idea, believes it could be a long-term solution to easing the pressure on an overburdened public healthcare system.

In Hong Kong, five in every 100 middle-aged men have sleep apnea. More men have it than women, Hui said. "More middle-age men are now obese. The increased neck fat can clog the airways, resulting in snoring and pauses in breathing, which meets the definition for sleep apnea."

Every year, Prince of Wales Hospital treats more than 1,000 patients who display signs of sleep apnea. About 400 take the diagnostic tests at home, after doctors have given them instructions on the machine, with the rest admitted to hospital.

"Despite many patients awaiting the test, we have only four beds for them," Hui said. "If we hadn't initiated the program, the waiting time would be much longer."

The home-based approach in treating milder chronic diseases has shown benefits for patients and front-line medical workers. One example is the continuous positive airway pressure therapy, or CPAP, given to sleep apnea patients.

Kong was one of hundreds selected to receive home-based therapy last year. In January, he was given a CPAP machine with a tight-fitting face mask to conduct overnight CPAP titration, the first step in alleviating sleep apnea. It allows doctors to assess the optimal air pressure needed to keep a patient's airway open during future CPAP treatments.