Doctors Who Make a Difference in Hawai‘i
Meet five Hawai‘i physicians that are doing important work in our local communities.
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Thanks to a local doctor, diagnosing sleep apnea in Hawai‘i is easier than ever.
By Katrina Valcourt
Dr. Shanon Makekau brought home testing to Hawai‘i, expanding access to sleep testing beyond overnight lab stays.
Photos: Olivier Koning
A GOOD NIGHT’S SLEEP CAN BE HARD TO COME BY. In fact, not sleeping well can be a real health problem: Sleep apnea, a condition in which you stop breathing in your sleep, affects more than 18 million people nationwide. Certain populations are more prone to the disorder than others and, in Hawai‘i, our diverse ethnicities and climbing obesity rates make the state a hotbed for the condition.
“Of all the different specialties in medicine, sleep medicine is probably one of the newest, if not the newest, fields,” says Dr. Shanon Makekau, director of the Sleep Lab in Kaiser Permanente Moanalua’s Department of Pulmonology. It’s the only lab in the state to test for apnea in patients’ own homes, rather than having them come in and spend the night hooked up to wires and monitors and videotaped as they sleep.
With home testing, patients strap to their wrists a watchlike device connected to a finger sensor that measures blood pressure, heart rate, oxygen levels and breathing with every heartbeat. The sensor sends data back to the watch, which stores it until the next morning, when patients return the device to the lab to download the results. Over the past few years, this little device has consistently proven very capable of diagnosing sleep apnea, and it only takes about five minutes to download the data.
A Maui native (and granddaughter of the founders of the Tasty Crust restaurant), Makekau became medical director of the lab eight years ago at age 32. She first saw home testing on the Mainland, where she did her training for sleep medicine, and decided to bring it back home to Hawai‘i because, at Kaiser, there are only six beds dedicated to the Sleep Lab.
“That’s six sleep studies per night,” she recalls thinking, “and a population of 200,000 patients, many of whom have undiagnosed sleep apnea. How are we going to close that gap?” The lab began home testing six and a half years ago, and Makekau expects that within three years 50 percent of Kaiser’s sleep studies will be done in the home. “With home testing, we’re able to expand access to sleep testing in a way that was unheard of before.”
This is especially important now, when we know that, in addition to patients who are obese, Pacific Islanders, Asian-Americans, Hispanics and African-Americans are more prone to sleep apnea. Hawai‘i’s cultural mix makes it the ideal place to pioneer innovative studies and further knowledge about this disorder, which is linked to other health issues. “The impact of sleep disorders is more far-reaching than almost anything I can imagine in medicine, and the ability to make a change and impact on all these different medical issues is tremendous,” Makekau says. And, as the mother of a 1- and 3-year-old who wake her up at dawn, she knows the importance of a good night’s sleep.
THE OTHER MAJOR THING Makekau wanted to change when she came to the Sleep Lab was patient education. “We can’t rely on telling patients what to do and expecting them to do it. That doesn’t really work. We have to be partners,” she says. She started holding forums a few times a month, in which people who were being tested for sleep disorders could learn more and find out what kinds of treatment to expect after diagnosis. “Nationwide, people who are diagnosed with sleep apnea tend to use the treatment only about 40 percent of the time,” she says, probably because the CPAP (continuous positive airway pressure) machine, which provides constant air pressure into patients’ lungs, is so intrusive. Since starting the forums, Makekau has seen an increase in patients sticking to their treatments and following through. “That partnership based on education is what makes our region in Hawai‘i very special. …
“I am proud to be able to give back and participate in the health and wellness of the families and communities in which I was raised,” says Makekau. “I think that a great accomplishment for any physician is to be able to have roots and wings, and I am so fortunate to have both.”