Home Apnea Monitoring / Home Cardiorespiratory Monitoring
DESCRIPTION
Home apnea monitors generally monitor respiratory effort and heart rate, and are typically utilized to monitor central apnea of prematurity in newly discharged at-risk or high-risk premature infants (infants are at increased risk of cardiorespiratory events until 43 weeks’ post-gestational age). An alarm will sound if there is respiratory cessation (central apnea) beyond a predetermined time limit (e.g., 20 seconds) or if the heart rate falls below a preset rate (bradycardia) to notify the parent that intervention (stimulation, mouth-to-mouth resuscitation, cardiac compressions) is required. Unless an oximeter is added to the two-channel devices, home apnea monitors are not effective at detecting obstructive sleep apneas. False alarms due to movement artifact are common with pulse oximeters, and these devices are not intended for the diagnosis of sleep-disordered breathing in a child.
Sudden infant death syndrome (SIDS) is the sudden death of an infant under one year of age; the circumstances are unexplained after a thorough investigation that includes autopsy, examination of the death scene, and review of the family history. As a means to decrease the incidence of SIDS, in the 1970’s cardiorespiratory monitoring was suggested. However over time, scientific medical studies have failed to establish that the use of home monitoring reduces the incidence of SIDS. The American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome in 2005, reiterates the recommendations of previous policy statements that home monitoring should not be used to reduce the incidence of SIDS. The American Academy of Pediatrics further recommends that proven practices should be promoted to reduce the incidence of SIDS which includes supine sleeping, pre-and post-natal exposure to cigarette smoking and a safe environment. The “Back to Sleep” Campaign initiated in 1994 by the National Institute of Child Health and Development (NICHD), Maternal Child Health Bureau of Human Resources and Services Administration, American Academy of Pediatrics and organizations concerned about SIDS is a national process to educate health care professionals, parents and caregivers about the significance of placing infants in the supine position to sleep to reduce SIDS. Since that time, statistics from the CDC 1998-2006 have shown that the incidence of SIDS has declined by 50%. This has in turn led to an overall decrease in utilization of home apnea monitors. Appropriate utilization of home cardio-respiratory monitoring may be used in the circumstances outlined in the policy section.
A number of infant apnea monitors have been cleared for marketing by the U.S. Food and Drug Administration (FDA). One device is the SmartMonitor 2 Apnea Monitor (Philip Children’s Medical Ventures, Respironics), which was cleared for marketing through the 510(k) process in October 2003. The intended use is for continuous monitoring of respiration, heart rate, and SpO2 of infant patients in a hospital or home environment.
POLICY
Home cardiorespiratory monitoring (i.e., pneumogram) for infants is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Home cardiorespiratory monitoring for infants who do not meet any of the medical appropriateness criteria below and with any siblings with a history of sudden death syndrome is considered not medically necessary.
Home cardiorespiratory monitoring in all other conditions/diseases, including but not limited to the diagnosis of obstructive sleep apnea, is considered investigational.
MEDICAL APPROPRIATENESS
Home cardiorespiratory monitoring for infants is considered medically appropriate if ALL of the following criteria are met:
The infant is younger than 12 months of age
The infant meets ANY ONE of the following:
They have experienced a life-threatening event
They have tracheostomies or anatomic abnormalities that make them vulnerable to airway compromise
They have neurologic or metabolic disorders affecting respiratory control, including central sleep apnea
They have chronic lung disease (e.g., bronchopulmonary dysplasia) and require supplemental oxygen, continuous positive airway pressure or mechanical ventilation
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
The American Academy of Pediatrics re-affirmed their 2003 policy on home apnea monitoring in 2007. The document notes that infants who may benefit from home monitoring include those who have experienced an apparent life-threatening event, have tracheostomies, have anatomic abnormalities that make them vulnerable to airway compromise, or have neurologic or metabolic disorders affecting respiratory control, including central sleep apnea, chronic lung disease including bronchopulmonary dysplasia and especially those individuals requiring supplemental oxygen, continuous positive airway pressure or mechanical ventilation. Furthermore, the AAP recommends that “if monitoring is to be used at home, parents and other caregivers must be trained in observation techniques, operation of the monitor, and infant cardiopulmonary resuscitation. Medical and technical support staff should always be available for direct or telephone consultation.”
SOURCES
American Academy of Pediatrics. (2007). Reaffirmed and retired policy. Pediatrics, 120 (3), 683-684.
BlueCross BlueShield Association. Medical Policy Reference Manual. (3:2011). Home Apnea Monitoring (1.01.06). Retrieved April 4, 2011 from BlueWeb. (7 articles and / or guidelines reviewed)
ORIGINAL EFFECTIVE DATE: 4/1981
MOST RECENT REVIEW DATE: 7/18/2011
ID_EBA
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.