Effect of the new Medicare guideline on patient qualification for positive airway pressure therapy.
BACKGROUND
New Medicare criteria for prescribing continuous positive airway pressure (CPAP) recognize hypopnea as a sleep disordered breathing event. In so doing, hypopnea was redefined as requiring a 4% oxygen desaturation. The criteria omit electroencephalogram (EEG) arousals from the definition. This study was designed to assess how the new Medicare guideline changes CPAP eligibility.


METHODS
Polysomnograms from 113 consecutive patients with obstructive sleep apnea were scored using both a definition for hypopnea that considered EEG arousals and the new Medicare definition that does not consider EEG arousal. CPAP eligibility was evaluated and compared.


RESULTS
Sixteen percent of all patients and 41% of patients apnea+hypopnea index </=20 did not qualify for CPAP under the new Medicare guidelines.


CONCLUSIONS
The new Medicare guidelines may underestimate OSA event occurrence and thereby deny CPAP therapy to many patients.
Raj
Rishi
R
Department of Medicine, VAMC Sleep Disorders and Research Center (III i) and Baylor College of Medicine, 2002 Holcombe Blvd., Room 6C-344, Houston, TX 77030, USA.
Hirshkowitz
Max
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017408:Guidelines as Topic; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D018579:Patient Selection; D017286:Polysomnography; D011175:Positive-Pressure Respiration; D020181:Sleep Apnea, Obstructive / Q000628:therapy*
D010100:Oxygen