BlueCross BlueShield of Tennessee Medical Policy Manual

Abbreviated Daytime Sleep Study (e.g. PAP-NAP)

DESCRIPTION

An abbreviated daytime sleep study (PAP NAP) has been explored to address poor compliance and enhance individual comfort and tolerance of CPAP/BiPAP. PAP NAP combines psychological and physiological treatments into one procedure during an abbreviated daytime nap session (100-120 minutes). Sleep technicians employ various coaching and monitoring techniques including mask and pressure desensitization, emotion focused therapy to overcome aversive responses to CPAP, mental imagery to divert the individuals attention from the sensations associated with CPAP and physiological exposure to CPAP.

Obstructive sleep apnea (OSA) or sleep apnea syndrome is a breathing disorder characterized by the cessation of breathing for at least ten seconds, which occurs repetitively throughout the night and is accompanied by hypoxia and hypercapnia.

Overnight polysomnography (PSG) testing is the standard diagnostic test performed for both adult and children. Despite efforts to individualize the treatment, adherence to prescribed therapy (e.g. CPAP, BiPAP) remains tenuous.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

Limited data from a single study of PAP-NAP is insufficient evidence to form conclusions on the efficacy of this approach in improving compliance with CPAP. No professional guidelines currently recommend use of PAP NAP as a compliance enhancement for either adults or children.

SOURCES

American Academy of Pediatrics (2012) Diagnosis and management of childhood obstructive sleep apnea syndrome. Retrieved April 25, 2017 from: www.pediatrics.org.

American Academy of Sleep Medicine. (2017). Diagnostic testing for adult obstructive sleep apnea: an american academy of sleep medicine clinical practice guideline Retrieved April 25, 2017 from http://www.journalsleep.org.

BlueCross BlueShield Association. Medical Policy Reference Manual. (11:2016). Diagnosis and medical management of obstructive sleep apnea syndrome. (2.01.18). Retrieved April 25, 2017 from BlueWeb. (47 articles and/or guidelines reviewed)

Centers for Medicare & Medicaid Services. CMS.gov. NCD for sleep testing for obstructive sleep apnea (OSA) (240.4.1). Retrieved June 29, 2016 from https://www.cms.gov.

Krakow, B., Ulibarri, V., Melendrez, D., Kikta, S., Togami, L., & Haynes, P. (2008). A daytime, abbreviated cardio-respiratory sleep study (CPT 95807-52) to acclimate insomnia patients with sleep disordered breathing to positive airway pressure (PAP-NAP). Journal of Clinical Medicine, 4 (3), 212-222. (Level 4 evidence)

Winifred S. Hayes, Inc. Medical Technology Directory (2012, October; last update search September 2016) Home sleep studies for diagnosis of obstructive sleep apnea syndrome in patients younger than 18 years of age. Retrieved April 25, 2017 from: http://www.hayesinc.com.

ORIGINAL EFFECTIVE DATE:  2/9/2014

MOST RECENT REVIEW DATE:  6/8/2017

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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.

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