AllMed Webinar Aids Health Plans in Determining When Sleep Studies are Medically Necessary

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Obstructive Sleep Apnea (OSA) is the most common type of sleep-disordered breathing. During a recent AllMed webinar, Dr. Bradley Davis, board certified in neurology and sleep medicine, discussed issues related to determining medical necessity of tests and procedures for (OSA). including both nonsurgical and surgical treatment options. "Despite the high prevalence of sleep disorders, sleep complaints often remain under-addressed" Dr. Davis noted, going on to say that OSA is a common chronic disorder that often requires long-term management. Potentially life-threatening complications associated with OSA may be avoided with early diagnosis.

Questions regarding OSA should be incorporated into routine health evaluations, and a suspected diagnosis of OSA should trigger a comprehensive sleep evaluation. Dr. Davis stressed that the impact of OSA goes beyond just losing sleep. Repetitive decreases in blood oxygen levels associated with OSA may eventually increase blood pressure, strain on the cardiovascular system, risk of hear attack, and risk of stroke.

"Weight loss is the simplest treatment for OSA in obese patients, "said Dr. Davis. He suggested that even a modest weight loss might eliminate apneic episodes by reducing the mass of the posterior airway. Patients with OSA who do not achieve permanent weight loss or who fail or cannot comply with other conservative treatment, such as nasal continuous positive airway pressure (CPAP), may be candidates for surgical interventions. According to the American Academy of Sleep Medicine (AASM), surgery can be considered as a primary treatment only in patients with mild OSA who have severe obstructing anatomy that is surgically correctable.

Many healthcare plans consider the diagnosis and treatment of OSA in adults aged 18 and older medically necessary when certain conditions are met. Dr. Davis cautioned that the presence or absence and severity of OSA must be determined before initiating treatment in order to identify patients at risk for developing complications of sleep apnea, to guide selections of appropriate treatment, and to provide a baseline to establish the effectiveness of subsequent treatment.

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