Abbreviated Daytime Sleep Study (e.g. PAP-NAP)
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.
An abbreviated daytime sleep study (PAP-NAP) used as a supplement to standard sleep studies for all indications, including but not limited to, the following is considered investigational:
correcting non-compliance, or improving compliance with prescribed CPAP
decreasing anxiety/claustrophobia associated with CPAP
mask and pressure desensitization
cognitive behavioral therapy (CBT)
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
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.
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.
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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