Moving toward Equitable Care for Sleep Apnea in the United States: Positive Airway Pressure Adherence Thresholds An Official American Thoracic Society Policy Statement

Martha E. Billings, Anna M. May, Najib T. Ayas, Ching Li Chai-Coetzer, Gary Ewart, Reena Mehra, Sairam Parthasarathy, Sanjay R. Patel, Terrance Showers, J. Daryl Thornton, Tilak K. Verma, Terri E. Weaver, Motoo Yamauchi, on behalf of the American Thoracic Society Assembly on Sleep and Respiratory Neurobiology

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)244-254
Number of pages11
JournalAmerican journal of respiratory and critical care medicine
Volume207
Issue number3
DOIs
Publication statusPublished - 1 Feb 2023

Keywords

  • continuous positive airway pressure
  • obstructive sleep apnea
  • race
  • sleep health disparities
  • socioeconomic position

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