Contesting medicalisation, doubting the diagnosis: patients' ambivalence towards the diagnosis of Obstructive Sleep Apnoea

Abstract

Whereas social scientific studies have investigated the emergence of the category Obstructive Sleep Apnoea (OSA), the most commonly diagnosed sleep disorder, no study has examined whether and how the ways in which OSA emerged affect patients' reception of the diagnosis. This article fills this gap by drawing upon in-depth interviews with 65 Israelis who received a laboratory diagnosis of OSA. This study finds that many patients doubt the accuracy of their diagnosis, and argues that this scepticism derives from contested macro-level medicalisation processes that preceed and surround the development of OSA as a diagnostic category. Specifically, past and present controversies over the definitions of OSA and its precursor the 'Pickwickian syndrome' created images of 'OSA patients' as sleepy and obese. Consequently, patients whose self-perception conflicted with this image questioned their diagnosis. Other patients argued that one night of sleep at a laboratory could not reflect their quality of sleep at home, thereby implicitly criticising the ways in which OSA was medicalised. This study enhances our understanding of the underexplored dynamics between the macro and micro levels of medicalisation.

‘Sometimes, it's easier to write the prescription’: physician and patient accounts of the reluctant medicalisation of sleeplessness

“…Related work highlights ambivalent medicalisation processes in which physicians have strongly negative or uncertain reactions to patients seeking opioid medication for pain (Crowley‐Matoka and True ) or attention deficit hyperactivity disorder diagnoses (Rafalovich ). Similarly, research on patients diagnosed with obstructive sleep apnoea (Zarhin ) reveals that patients may question or reject their diagnosis, often leading to treatment non‐compliance. Attitudes of ambivalence seem most closely tied to conditions that fit the biomedical model yet remain stigmatised due to perceptions of deviance (for example, addiction, obesity, bad behaviour).…”

“…Comparatively, our understanding of the interactional level is limited, but there seems to be a shift in the analytic gaze from institutions to individuals and interactions (Barker 2008, Figert 2011. Recent work highlights the ways in which medicalisation may be partial or incomplete at one or more levels (Halfmann 2012, Zarhin 2015. By acknowledging the multilevelled nature of medicalisation, scholars may explore incomplete, 'ambivalent' medicalisation processes in which institutionally and conceptually medicalised conditions are contested by physicians or patients (see Crowley-Matoka and True 2012, Rafalovich 2005, Zarhin 2015.…”

“…The idea that some conditions are perhaps more easily medicalised than others is not new (see Conrad and Schneider 1992), but has only recently been examined within the sociology of sleep. For instance obstructive sleep apnoea, the most commonly diagnosed sleep disorder, appears to face contestation at the patient level (see Zarhin 2015). In addition, the concept of 'shiftwork sleep disorder' has transformed a social problem into a medical one, yet remains contested (Williams et al 2013: 41).…”

“…This research builds upon recent work highlighting the dynamic interaction between various levels of medicalisation (Halfmann 2012, Zarhin 2015. In addition to exploring micro and macro dynamics, I identify the ways in which Conrad's engines of medicalisation (2007,2013) are present and influential in the routine office visit, and appear in both patients' and physicians' accounts.…”

“…Some sociological studies have explored the patient perspective on sleep problems and solutions (Coveney , Gabe and Thorogood , Gabe et al . , Hislop and Arber , Venn and Arber , Zarhin ). Other researchers have solicited the practitioner perspective (Dyas et al .…”