Medicare to Cover Sleep Disorder Treatments

On March 3, 2009, the Centers for Medicare & Medicaid Services announced that Medicare will cover sleep testing for the diagnosis of obstructive sleep apnea.

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. * * *

The announcement was noted in a brief article entitled Medicare to pay for sleep apnea tests posted on March 16, 2009, by American Medical News, a service of the American Medical Association.

Some local Medicare contractors have covered the sleep exams, which can range from simple home tests to more complex exams done in a sleep laboratory, but Medicare has lacked a national coverage policy on the testing.

"Medicare beneficiaries who have obstructive sleep apnea face significant risks for cardiovascular disease and other ailments," said CMS Acting Administrator Charlene Frizzera. "This coverage decision establishes nationally consistent coverage and assures that beneficiaries who have sleep apnea can be appropriately diagnosed and referred for treatment."

The relevant CMS coverage memorandum is available online under the heading Decision Memo for Sleep Testing for Obstructive Sleep Apnea (OSA) (CAG-00405N).

An article dated May 1, 1999, entitled Sleep Problems in the Elderly, by David N. Neubauer, M.D., of the Johns Hopkins Sleep Disorders Center, Baltimore, Maryland, posted by the American Academy of Family Physicians, reviewed the incidence of sleep disorders in the elderly.

Complaints of sleep difficulty are common among the elderly. In a National Institute on Aging study of over 9,000 persons aged 65 years and older, over one half of the men and women reported at least one chronic sleep complaint.

Typical symptoms of sleep problems in the elderly include difficulty falling asleep and maintaining sleep, early-morning awakening and excessive daytime sleepiness.

A variety of processes may interfere with sleep and wakefulness in the elderly. Among them are acute and chronic medical illnesses, medication effects, psychiatric disorders, primary sleep disorders, social changes, poor sleep habits and circadian rhythm shifts. Sleep-wake problems may be compounded further by inappropriate treatment initiated by the patient, family members, physicians or other care providers.

The consequences of chronic sleep problems can be considerable. Loss of sleep or chronic use of sedating medications may lead to falls and accidents. Sleep-disordered breathing may have serious cardiovascular, pulmonary and central nervous system effects.

Evidence supports a strong association between sleep apnea and hypertension.6-8 In persons with dementia, severe sleep disruption often leads to nursing home placement.

For all of these reasons, sleep problems in elderly patients should be properly evaluated and treated. * * *

The National Institutes of Health provides an answer to the question What Is Sleep Apnea?

Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.

Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep 3 or more nights each week. You often move out of deep sleep and into light sleep when your breathing pauses or becomes shallow.

This results in poor sleep quality that makes you tired during the day. Sleep apnea is one of the leading causes of excessive daytime sleepiness. * * *

The NIH article noted the dangers associated with untreated sleep apnea, which can:

• Increase the risk for high blood pressure, heart attack, stroke, obesity, and diabetes
• Increase the risk for or worsen heart failure
• Make irregular heartbeats more likely
• Increase the chance of having work-related or driving accidents

Lifestyle changes, mouthpieces, surgery, and/or breathing devices can successfully treat sleep apnea in many people. * * *

A connection between sleep apnea and stroke was highlighted in a 2006 study. In Sleep Apnea Ups Stroke Risk in Elderly (08/30/06), by Jennifer Warner, posted by WebMD Health News, it was reported that "[o]lder adults with sleep apnea may face a more than doubled risk of stroke, according to a new study."

Researchers found undiagnosed sleep apnea increased the risk of stroke by 2.5 times among the elderly. Previous studies have linked severe sleep apnea to strokes in middle-aged adults, but researchers say this is the first study to show an increased risk associated with the sleep disorder among older adults. * * *

In the study, published in Stroke: Journal of the American Heart Association, researchers followed nearly 400 adults between the ages of 70 and 100 for six years. Each was evaluated for sleep apnea at the start of the study.

During the study period, 20 strokes were reported. Participants with previously undiagnosed severe sleep apnea were 2.5 times more likely to have a stroke, regardless of their other traditional stroke risk factors such as high blood pressure, smoking, and cholesterol levels. * * *

Thus, as we age, obstructive sleep apnea creates greater risks for general health. Diagnosing and treating sleep disorders in elders covered by Medicare is a step forward for better health.