SleepMedRx founder and CEO Jagdeep Bijwadia, MD, MBA, on why recognizing co-existing disorders, such as cardiac comorbidities, should be a priority for sleep specialists.

By Chaunie Brusie, RN, BSN

You could say that Jagdeep Bijwadia, MD, MBA, the founder and CEO of SleepMedRx, is something of a pioneer. Long before the world went remote, Bijwadia, who lives in St. Paul, Minn, launched his company as a telehealth sleep medicine service. While he says a telehealth-focused sleep medicine company was not as “easily adopted” before the pandemic, he was confident in his decision to pursue more avenues to reach more patients.

Driving his actions is the belief that sleep is only one marker of health—and that the diagnosis of a sleep disorder points to the necessity of investigating comorbidities.

“Sleep, as we well know, impacts every aspect of health, and investigations of links between cardiovascular disorders and sleep apnea go back many years,” Bijwadia says. “Sleep apnea has been implicated, in either causation or worsening of, overall mortality, hypertension, heart failure, coronary artery disease, and various arrhythmias.”

With a background in pulmonary medicine, Bijwadia’s interest in the cardio-sleep connection built gradually over his years of practice. But now, thanks to evidence in his clinical practice and more literature citing the presence of cardiovascular comorbidities alongside sleep disorders, Bijwadia focused more closely on making sure both disorders are proactively addressed in his patients.

Born of Necessity

After finishing his fellowship in pulmonary medicine, Bijwadia moved to a small town in Virginia where he says there were no sleep specialists for at least a 100-mile radius. This led him to learn the specialty out of “necessity.”

“Over the years as my career progressed and my interest in the science and practice of sleep medicine grew, I continued to increase my time and focus on sleep disorders,” Bijwadia says. He headed the sleep program at the University of Minnesota for several years before founding SleepMedRx in 2017. “SleepMedRx was a natural progression to pursuing my passion,” he says. “The combination of home sleep testing and telehealth allowed me to develop workflows and partnerships that reached more patients.”

Like the early drivers of turning to sleep medicine out of necessity, the evolution to the importance of understanding the cardio-sleep connection soon became clear to Bijwadia. He points out, for instance, that in 2022, the American Heart Association added sleep as an essential pillar for cardiovascular health along with other preventive measures like managing blood pressure and cholesterol. The interest in the cardio-sleep connection is something Bijwadia has also seen reflected on a clinical level; in the last several years he has “definitely experienced increasing awareness and referrals from our cardiology colleagues,” he says.

Bijwadia admits that it’s a “difficult question” to discern whether the sleep or the cardiovascular disorder originates first, as with recurrent arousals, the intermittent hypoxemia and systemic inflammation experienced by patients with sleep apnea can directly lead to cardiovascular consequences. “We know that both sleep apnea and cardiovascular disease have high prevalence and often co-exist in our patients,” he explains, adding that while there is “tantalizing data” that suggests long-standing sleep apnea is indeed causal to the development of future cardiovascular disorders, the evidence is not conclusive.1

At the very least, what is known is that the presence of sleep apnea can certainly worsen outcomes for patients with underlying cardiovascular disorders, making early identification and treatment a priority for sleep specialists on both ends of the spectrum, Bijwadia says. 

Getting to the Heart of the Matter

SleepMedRx is structured with a two-step approach: first with a consult and study to establish the sleep diagnosis and the second step taking follow-up actions for all possible related health conditions.

He points out that the sleep disorder and cardiac comorbidities are often just the tip of the iceberg. “When you evaluate a patient with a sleep disorder, sleep apnea is usually one of many problems the patient might have,” he says. “The sleep apnea is often an interaction with other issues and all of those impacted by the first diagnosis of a sleep disorder. And a sleep disorder points to cardiac but also pulmonology and other issues.”

Just how critical is making the cardio-sleep connection? Bijwadia points to an example identified through one of SleepMedRx’s diagnostic partners, VirtuOx, capable of home sleep testing and cardiac telemetry.

A patient who presented with chronic obstructive pulmonary disease (COPD) had shortness of breath ascribed to his poor lung function—but sleep testing revealed a high central apnea index that led Bijwadia to order an echocardiogram. The echo identified previously undetected advanced heart failure due to unrecognized ischemic heart disease (the patient subsequently underwent angiography and coronary artery stenting).

“When looking at a sleep test report, pay attention to the clues that might point to the need for cardiac workup,” he says. “For our primary care colleagues, it is important to remember that patients with cardiac disease may minimize or often ascribe their symptoms of daytime fatigue or poor sleep quality to their heart issues, but it is important to keep suspicion for sleep disorders high.”

Kyle Miko, CRT/CSE, the founder and chief marketing officer of VirtuOx, says that with Bijwadia as one of the few pulmonologists and sleep physicians licensed in all 50 states, Bijwadia’s collaborative approach to looking toward the bigger picture of sleep and overall health has been formative. 

“We have our work cut out for us as not many sleep doctors understand the connection of sleep and heart health,” Miko says. “With the work we are doing and with Jagdeep, we can help educate the physician community that if you want to fix the heart, you’ve got to fix the sleep first.”

Making the Connection

To help foster identifying the connection between sleep and heart health, Bijwadia and his team at SleepMedRx are also working on technology partnerships for managing insomnia.

“With few reimbursement options, insomnia is a poorly managed condition that is even more prevalent than sleep apnea, and patients have very few evidence-based options,” he says. “Even in patients without sleep apnea, sleep duration and quality have huge cardiac and other health implications.”

Overall, Bijwadia is driven by the idea of simplifying the journey of diagnosing and treating sleep disorders, as well as expanding the availability of sleep diagnostics and treatment.

He believes that the advent of new strategies through companies like his own, which uses disposable and multinight sleep testing, can increase the accuracy and reliability of results and thus drive individualized treatment solutions. Bijwadia also points to what he calls differentiators in sleep medicine spaces, such as SleepMedRx’s status as physician-owned with a clinician training program as well as partnerships with home sleep testing and treatment providers that allow for a blend of cash pay and payer reimbursed pathways.

“The journey starts with implementing tools and programs for education and increased awareness on both sides,” he says. “Cardiologists should work with their sleep specialist colleagues to develop and implement easily scalable programs to screen patients at risk and be able to rely on sleep specialists to establish a diagnosis and initiate effective treatment as well as ongoing monitoring of the sleep disorder. Comprehensive care and communication are absolutely key.”

Bijwadia stresses that his work is about highlighting the bigger picture of how sleep sits at the focal point of many other interactions within the body. “It’s about recognizing the impact on other disorders,” he says.

Identifying cardiac continuations after a sleep study is just one of the many follow-up avenues he hopes to promote among sleep practitioners. “Asthma, COPD, depression—we should be thinking of all of those as part of the management of sleep,” he says. More importantly, following up on those interactions and co-existing conditions will make a crucial difference in improving patients’ health and quality of life.

Reference

1. Yeghiazarians Y, Jneid H, Tietjens JR, et al. Obstructive sleep apnea and Cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021;144(3):e56-67.

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