Abstract
This document summarizes suggestions of the central sleep apnea (CSA) Technical Expert Panel working group. This paper shares our vision for bringing the right device to the right patient at the right time. For patients with CSA, current coverage criteria do not align with guideline treatment recommendations. For example, CPAP and oxygen therapy are recommended but not covered for CSA. On the other hand, bilevel positive airway pressure (BPAP) without a backup rate may be a covered therapy for OSA, but it may worsen CSA. Narrow coverage criteria that require near elimination of obstructive breathing events on CPAP or BPAP in the spontaneous mode, even if at poorly tolerated pressure levels, may preclude therapy with BPAP with backup rate or adaptive servoventilation, even when those devices provide demonstrably better therapy. CSA is a dynamic disorder that may require different treatments over time, sometimes switching from one device to another; an example is switching from BPAP with backup rate to an adaptive servoventilation with automatic end-expiratory pressure adjustments, which may not be covered. To address these challenges, we suggest several changes to the coverage determinations, including: (1) a single simplified initial and continuing coverage definition of CSA that aligns with OSA; (2) removal of hypoventilation terminology from coverage criteria for CSA; (3) all effective therapies for CSA should be covered, including oxygen and all PAP devices with or without backup rates or servo-mechanisms; and (4) patients shown to have a suboptimal response to one PAP device should be allowed to add oxygen or change to another PAP device with different capabilities if shown to be effective with testing.
Original language | English (US) |
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Pages (from-to) | e419-e425 |
Journal | CHEST |
Volume | 160 |
Issue number | 5 |
DOIs | |
State | Published - Nov 2021 |
Funding
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: T. I. M. has served as a consultant for Withings, Respicardia, Inc, and has received research funding from Withings and AR Medical Technologies Inc. A. M. is funded by National Institutes of Health (NIH). He reports income from Equillium, Corvus and Livanova related to medical education. ResMed provided a philanthropic donation to UC San Diego. R. B. B. serves on scientific advisory board of Cerebra. M. R. is a partial owner of Greater Washington Sleep Disorders Centers. None declared (K. G. J.). Financial/nonfinancial disclosures: The authors have reported to CHEST the following: T. I. M. has served as a consultant for Withings, Respicardia, Inc, and has received research funding from Withings and AR Medical Technologies Inc. A. M. is funded by National Institutes of Health (NIH). He reports income from Equillium, Corvus and Livanova related to medical education. ResMed provided a philanthropic donation to UC San Diego. R. B. B. serves on scientific advisory board of Cerebra. M. R. is a partial owner of Greater Washington Sleep Disorders Centers. None declared (K. G. J.). ?ONMAP Technical Expert Panel members: Overall Chairs: Peter C. Gay, MD, FCCP, and Robert L. Owens, MD. Thoracic Restrictive Disorders: Chair/Co-Chair?Lisa F. Wolfe, MD, FCCP, and Joshua O. Benditt, MD, FCCP. Thoracic Restrictive Disorders Committee Members?Loutfi S. Aboussouan, MD, FCCP, John M. Coleman III, MD, and Dean R. Hess, PhD, RRT. COPD: Chair/Co-chair?Nicholas S. Hill, MD, FCCP, and Gerard J. Criner, MD, FCCP. COPD Committee Members?Richard D. Branson, MSc, RRT, Bartolome R. Celli, MD, FCCP, Neil R. MacIntyre, MD, FCCP, and Amen Sergew, MD. Central Sleep Apnea: Chair/Co-Chair?Timothy I. Morgenthaler, MD, and Atul Malhotra, MD, FCCP. Central Sleep Apnea Committee Members?Richard B. Berry, MD, Karin G. Johnson, MD, and Marc I. Raphaelson, MD. Hypoventilation: Chair/Co-chair?Babak Mokhlesi, MD, FCCP, and Christine H. Won, MD. Hypoventilation Committee Members?Bernardo J. Selim, MD, FCCP, Barry J. Make, MD, FCCP, and Bernie Y. Sunwoo, MBBS. OSA: Chair/Co-chair?Nancy A. Collop, MD, Master FCCP, and Susheel P. Patil, MD, PhD. OSA Committee Members?Alejandro D. Chediak, MD, FCCP, Eric J. Olson, MD, and Kunwar Praveen Vohra, MD, FCCP.
Keywords
- CPAP
- central sleep apnea
- noninvasive ventilation
- oxygen
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
- Cardiology and Cardiovascular Medicine
- Pulmonary and Respiratory Medicine