The Wall Street Journal-20080113-Health Costs- Testing for Sleep Apnea
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Health Costs: Testing for Sleep Apnea
Chronic sleep problems can be a nightmare, increasing the risk of everything from heart ailments to depression to car crashes. Now, Medicare is proposing to make it easier for seniors to get diagnosed and treated for one of the most common disorders, obstructive sleep apnea.
The problem occurs when people stop breathing for at least 10 seconds, as their throat muscles relax and collapse into their airways. Sufferers endure an exhausting pattern: sleeping, then starting suddenly awake, gasping for air. Medicare figures that about 4% of men and 2% of women in the under-65 population, and up to 10% of people 65 and older, or about four million people, have obstructive sleep apnea. Other experts put the estimate far higher.
The recommended treatment is usually "continuous positive airway pressure," or CPAP. During sleeping hours, air is blown through a face mask at a steady rate to keep air passages open. Currently, Medicare covers the treatment only for beneficiaries diagnosed by a sleep test, called a polysonogram, which costs about $1,500 and is administered in a special sleep lab.
Medicare has proposed covering the treatment for seniors diagnosed by less-expensive home tests that cost about $500. Doctors can show patients how to use the gadget -- a small computer the size of an iPod and various tubes and belts. The patient straps himself in at night, and takes the device back to the doctor the next day to interpret the results.
Ear-nose-and-throat doctors, who are pressing for the change, say it would encourage many more people to be diagnosed and treated. "There's an enormous backlog" at the sleep labs, says Terence Davidson, a professor at the University of California, San Diego, School of Medicine. As a result, he says, only about 10% of people with sleep apnea have been diagnosed. Further, he says, older people often resist going to a lab, insisting on "sleeping in their own bed."
But many doctors who are sleep specialists are unhappy about the proposal, which they say could compromise care. The sleep tests are more complicated than they seem, they say, and have to be supervised by well-trained technicians and doctors. Currently, patients suspected of having the disorder go through two lab sessions -- to make the diagnosis and to set the proper pressure for the CPAP. If home tests are interpreted by physicians without training in sleep medicine, "there's a risk of a wrong diagnosis, or of the pressure not being set at the right level," says Nancy Collop, an associate professor of medicine at Johns Hopkins University and a member of the board of the American Academy of Sleep Medicine.
Currently, Medicare and most private insurers, besides paying for the CPAP treatment, also cover facility-based testing. The new proposal doesn't specifically call for Medicare to cover home tests, but it doesn't rule it out either. Medicare officials and many doctors expect that home tests eventually will be paid for both by the government and private insurance.
The proposal, which could be altered before being finalized in March, also would limit initial coverage of CPAP to 12 weeks. But the coverage would be extended if the patient shows he or she is benefiting.
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