"please keep me updated about oximeters "
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Should We Treat Asymptomatic Sleep Apnea?
Anyone disagree and think we're being selfish putting forth our agenda?
Views: 324
Replies to This Discussion
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Permalink Reply by Mary Z on
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I think imminent death could be in our future just not as likely as for those with ARDS.
I also think that unsymptomatic sleep apnea is much less likely to be diagnosed and treated. My roommate snores, but I don't hear any apnea events so I haven't asked her to be seen. I agree with your conclusion- there's plenty of CPAP to go around. I don't mind getting bumped to the bottom of the waiting list at a sleep clinic as I am already being treated and if someone more acute came along they should be seen first. I don't see us as selfish in putting forth our agenda, rather as being proactive about our health.
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Permalink Reply by RockRpsgt on
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Maybe I missed something. Why can't everyone get treated? Those that need it the most should go to the front of the line. Most labs have protocols that do this.
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Symptoms are not a requirement for treatment. Only for the initiation of the study. All that is required for treatment is an AHI>5. To run a split study on a person with mild apnea (AHI 5-15) the pt must be symptomatic in some way ie; EKG arrythmias, hypertension, EDS etc..etc
https://www.cms.gov/Transmittals/downloads/R35NCD.pdf
240.4 – Continuous Positive Airway Pressure (CPAP) Therapy For Obstructive Sleep Apnea (OSA) (Effective April 4, 2005)
(Rev.35, Issued: 05-06-05, Effective: 04-04-05, Implementation: 06-06-05)
A. General
Continuous positive airway pressure (CPAP) is a non-invasive technique for providing single levels of air pressure from a flow generator, via a nose mask, through the nares. The purpose is to prevent the collapse of the oropharyngeal walls and the obstruction of airflow during sleep, which occurs in obstructive sleep apnea (OSA).
B. Nationally Covered Indications
The use of CPAP is covered under Medicare when used in adult patients with moderate or severe OSA for whom surgery is a likely alternative to CPAP. The use of CPAP devices must be ordered and prescribed by the licensed treating physician to be used in adult patients with moderate to severe OSA if either of the following criterion using the Apnea-Hypopnea Index (AHI) are met:
• AHI greater than or equal to 15 events per hour, or
• AHI greater than or equal to 5 and less than or equal to 14 events per hour with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke.
The AHI is equal to the average number of episodes of apnea and hypopnea per hour and must be based on a minimum of 2 hours of sleep recorded by polysomnography using actual recorded hours of sleep (i.e., the AHI may not be extrapolated or projected).
Apnea is defined as a cessation of airflow for at least 10 seconds. Hypopnea is defined as an abnormal respiratory event lasting at least 10 seconds with at least a 30 percent reduction in thoracoabdominal movement or airflow as compared to baseline, and with at least a 4 percent oxygen desaturation.
The polysomnography must be performed in a facility - based sleep study laboratory, and not in the home or in a mobile facility.
Initial claims must be supported by medical documentation (separate documentation where electronic billing is used), such as a prescription written by the patient's attending physician that specifies:
• A diagnosis of moderate or severe obstructive sleep apnea, and
• Surgery is a likely alternative.
The claim must also certify that the documentation supporting a diagnosis of OSA (described above) is available.
C. Nationally Non-covered Indications
Effective April 4, 2005, the Centers for Medicare & Medicaid Services determined that upon reconsideration of the current policy, there is not sufficient evidence to conclude that unattended portable multi-channel sleep study testing is reasonable and necessary in the diagnosis of OSA for CPAP therapy, and these tests will remain noncovered for this purpose.
D. Other
N/A
(This NCD last reviewed April 2005.)
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Well done jnk! I am guessing that you were once a lumberjack and now a carpenter. There is nothing you won't knock down and rebiuld in your own light. You have just completely dissected and put into a bad light a system that is used to help people everyday. Post like these turn people away from getting the help that they need.
This post documents your own "impaired cognition" and "Mood disorder". If you need a reference you know where to find me. :)
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Sarcasm noted.
j n k said:Perhaps you missed my point, Rock. (My fault. My sarcasm is not always well worded.) So I'll restate my point from another angle, if that's OK:
If there is a relatively inexpensive medical product that helps many people to breathe better while asleep and thus greatly improves their quality of life, why would anyone look for ways to withhold that product from the people whose lives would be improved by it? As with so many other medical treatments, patient response to the treatment is part of the diagnosis. So a good doctor will find a way to make sure his patient qualifies for what will improve that patient's life, despite any attempts by bean-counters to regulate and tamper with the doctor-patient relationship.
I hope that is clearer.
jeff
Rock Hinkle said:Well done jnk! I am guessing that you were once a lumberjack and now a carpenter. There is nothing you won't knock down and rebiuld in your own light. You have just completely dissected and put into a bad light a system that is used to help people everyday. Post like these turn people away from getting the help that they need.
This post documents your own "impaired cognition" and "Mood disorder". If you need a reference you know where to find me. :)
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I would have thought I was asymptomatic when my sleep apnea first started. All I was doing was taking four or five hour afternoon naps every day, in which I was dead to the world, doorbell, phone, or dogs barking. I thought is was my bipoar disorder and I loved those naps. Only after I began falling asleep on my feet at 9:00AM in the morning, fall asleep at appointments and was unable to drive did I think I had symptoms. I thought, boy this came on out of the blue when I was diagnosed. In reality those naps were when sleep apnea really started to affect me.
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