When patients with OSA fall asleep muscles of this region may relax to the point of permitting airway collapse and obstruction. The anatomic site of obstruction is thought to be the soft palate, extending to the base of the tongue. During the obstructive apnea episodes, either complete or partial obstruction of the airway occurs. The apnea episodes often last for a minute or longer, and can occur hundreds of times during a single night’s sleep. Patients suffering with sleep apnea may literally stop breathing (apnea) for a short period or have decreased breathing (hypopnea), repeatedly during sleep. Of the three different forms of sleep apnea (obstructive, central, or mixed), OSA is the most common. The most common clinical presentation of patients with OSA is obesity accompanied by excessive daytime drowsiness (20% of adults with BMI > 30 have OSA), although other clinical findings associated with OSA include nocturnal choking or gasping, witnessed apneas during sleep, large neck circumference and daytime fatigue. Untreated OSA is associated with a ten-fold increased risk of motor vehicle accidents (Teran-Santos et al. It is estimated that 10% of patients with congestive heart failure (CHF) have OSA, which is independently associated with systemic arterial hypertension (Caples et al.
Complications associated with OSA include excessive daytime sleepiness, concentration difficulty, coronary artery disease, and stroke (Kokturk et al. The prevalence increases with age (up to 10% in persons 65 and older), as well as with increased weight. It is a commonly underdiagnosed condition that occurs in 4% of men and 2% of women (Young et al.
OSA, sometimes referred to as Obstructive Sleep Apnea Hypopnea Syndrome-(OSAHS), is associated with significant morbidity and mortality. However, it does not exclude these tests being performed in other settings to include a sleep lab. We use the abbreviation HST (home sleep test) to refer to unattended multichannel sleep testing or multichannel sleep monitoring typically furnished in the beneficiary’s home. We note that some authors use the abbreviation NPSG to mean nocturnal PSG. Unless we specifically describe an unattended use, we will always assume in this document that it has been attended. We use the abbreviation PSG to refer to polysomnography or a polysomnogram furnished in a sleep laboratory facility. Subject: Coverage Decision Memorandum for Sleep Testing for Obstructive Sleep Apnea (OSA) (CAG-00405N) Sleep Testing for Obstructive Sleep Apnea (OSA) Type I Polysomnography (PSG) is covered when used to aid the diagnosis of obstructive sleep apnea (OSA) in beneficiaries who have clinical signs and symptoms indicative of OSA if performed attended in a sleep lab facility.Ī Type II or a Type III sleep testing device is covered when used to aid the diagnosis of obstructive sleep apnea (OSA) in beneficiaries who have clinical signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility.Ī Type IV sleep testing device measuring three or more channels, one of which is airflow, is covered when used to aid the diagnosis of obstructive sleep apnea (OSA) in beneficiaries who have signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility.Ī sleep testing device measuring three or more channels that include actigraphy, oximetry, and peripheral arterial tone is covered when used to aid the diagnosis of obstructive sleep apnea (OSA) in beneficiaries who have signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility. CMS finds that the evidence is sufficient to determine that the results of the sleep tests identified below can be used by a beneficiary’s treating physician to diagnose OSA, that the use of such sleep testing technologies demonstrates improved health outcomes in Medicare beneficiaries who have OSA and receive the appropriate treatment, and that these tests are thus reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act.
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