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.