Contemporary issues in the diagnosis and treatment of obstructive sleep apnea

Obstructive sleep apnea (OSA) is a common disease associated with significant morbidity and use of health care resources. Therapy with continuous positive airway pressure (CPAP) devices has low risk and a potentially large benefit in treating this disease. The Centers for Medicare and Medicaid Services (CMS) recently issued a memo revising their earlier position that authorized payment for CPAP only if formal polysomnography (PSG) was performed and was diagnostic for OSA. The revised memo states that CMS will be pay for CPAP therapy for 12 weeks (and subsequently if OSA improves) for adults diagnosed with either PSG or with unattended home sleep monitoring devices. The use of portable home monitoring devices can greatly increase access to diagnosis and treatment of OSA. However, these devices must be used as part of a comprehensive sleep evaluation program that includes access to board-certified sleep specialists, PSG facilities, and therapists experienced in fitting and troubleshooting CPAP devices.