TY - JOUR
T1 - Moving toward Equitable Care for Sleep Apnea in the United States
T2 - Positive Airway Pressure Adherence Thresholds An Official American Thoracic Society Policy Statement
AU - Billings, Martha E.
AU - May, Anna M.
AU - Ayas, Najib T.
AU - Chai-Coetzer, Ching Li
AU - Ewart, Gary
AU - Mehra, Reena
AU - Parthasarathy, Sairam
AU - Patel, Sanjay R.
AU - Showers, Terrance
AU - Thornton, J. Daryl
AU - Verma, Tilak K.
AU - Weaver, Terri E.
AU - Yamauchi, Motoo
AU - on behalf of the American Thoracic Society Assembly on Sleep and Respiratory Neurobiology
PY - 2023/2/1
Y1 - 2023/2/1
N2 - Background: Positive airway pressure (PAP) is a highly effective treatment for obstructive sleep apnea (OSA), but adherence limits its efficacy. In addition, coverage of PAP by CMS (Centers for Medicare & Medicaid Services) and other insurers in the United States depends on adherence. This leaves many beneficiaries without PAP, disproportionally impacting non-white and low socioeconomic position patients with OSA and exacerbating sleep health disparities. Methods: An inter-professional, multidisciplinary, international committee with various stakeholders was formed. Three working groups (the historical policy origins, impact of current policy, and international PAP coverage models) met and performed literature reviews and discussions. Using surveys and an iterative discussion-based consensus process, the policy statement recommendations were created. Results: In this position paper, we advocate for policy change to CMS PAP coverage requirements to reduce inequities and align with patient-centered goals. We specifically call for eradicating repeat polysomnography, eliminating the 4-hour rule, and focusing on patient-oriented outcomes such as improved sleepiness and sleep quality. Conclusions: Modifications to the current policies for PAP insurance coverage could improve health disparities.
AB - Background: Positive airway pressure (PAP) is a highly effective treatment for obstructive sleep apnea (OSA), but adherence limits its efficacy. In addition, coverage of PAP by CMS (Centers for Medicare & Medicaid Services) and other insurers in the United States depends on adherence. This leaves many beneficiaries without PAP, disproportionally impacting non-white and low socioeconomic position patients with OSA and exacerbating sleep health disparities. Methods: An inter-professional, multidisciplinary, international committee with various stakeholders was formed. Three working groups (the historical policy origins, impact of current policy, and international PAP coverage models) met and performed literature reviews and discussions. Using surveys and an iterative discussion-based consensus process, the policy statement recommendations were created. Results: In this position paper, we advocate for policy change to CMS PAP coverage requirements to reduce inequities and align with patient-centered goals. We specifically call for eradicating repeat polysomnography, eliminating the 4-hour rule, and focusing on patient-oriented outcomes such as improved sleepiness and sleep quality. Conclusions: Modifications to the current policies for PAP insurance coverage could improve health disparities.
KW - continuous positive airway pressure
KW - obstructive sleep apnea
KW - race
KW - sleep health disparities
KW - socioeconomic position
UR - http://www.scopus.com/inward/record.url?scp=85147186444&partnerID=8YFLogxK
U2 - 10.1164/rccm.202210-1846ST
DO - 10.1164/rccm.202210-1846ST
M3 - Article
C2 - 36722719
AN - SCOPUS:85147186444
SN - 1073-449X
VL - 207
SP - 244
EP - 254
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 3
ER -