Criteria: CWQI: HCS-0080, HCS-0081, HCS-0082, HCS-0083 (This criteria is consistent with CMS guidelines for Sleep Studies)

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1 Page 1 of 16 Approved: Mary Engrav, MD Date: 6/24/2015 Description: Airway obstruction during sleep is a commonly recognized problem. Obstructive sleep apnea (OSA) is the most common breathing related sleep disorder. OSA is characterized by repetitive episodes of airway obstruction due to the collapse and obstruction of the upper airway during sleep. In patients with OSA, the normal pharyngeal narrowing is accentuated by anatomic factors, such as a short neck, elongated palate and uvula, large tonsils and redundant lateral pharyngeal wall mucosa. The hallmark symptom of OSA is excessive snoring with related apneic episodes, resulting in excessive daytime sleepiness affecting the patient s Activities of Daily Living. The incidence of OSA in obese patients is considerably higher than in nonobese individuals. Criteria: CWQI: HCS-0080, HCS-0081, HCS-0082, HCS-0083 (This criteria is consistent with CMS guidelines for Sleep Studies) I. Moda Health will cover a Sleep Study for obstructive sleep apnea if All of the following are met: a. A sleep study is indicated if the patient meets 1 or more of the following criteria for signs and symptoms obstructive sleep apnea (OSA). (see criteria below for the specific type of sleep study to be performed) i. Epworth Sleepiness Scale greater than 10 ii. Significant snoring with snorting, gasping, or choking episodes associated with awakenings iii. Observed apneic episodes iv. Excessive daytime sleepiness that is affecting Activities of Daily Living (ADLs) v. Craniofacial abnormalities or neuromuscular disease b. For patients meeting the criteria OSA, a Sleep Study will be covered for 1 or more of the following: i. A Home Sleep Study (CWQI HCS-0080) will be covered for ALL of the following: 1. The patient does not have 1 or more of the following contraindications: a. Age is less than 18 b. COPD c. CHF d. Cognitive impairment (inability to follow simple instructions)

2 Page 2 of 16 e. Neuromuscular disorder f. Suspicion of central sleep apnea, parasomnias, or periodic limb movement g. Oxygen dependence h. History of cardiac dysrhythmias 2. A home sleep study is performed on Type II, Type III, or Type IVA device, capable of measuring airflow and at least 2 channels, and provides measurement of apnea-hypopnea index (AHI), and All of the following: a. The home sleep study is interpreted by a Board Certified Sleep Medicine Specialist. 3. The request is Not for devices that do not provide standard measurement of AHI and oxygen saturation. These devices do not provide sufficient information to prescribe treatment. (Examples include Biancamed SleepMinder, SNAP testing with fewer than 3 channels, and SleepImage Sleep Quality Screener) c. For patients with a positive home sleep study, AutoPAP will be medically necessary for titration and treatment with 1 or more of the following: i. The patient has an Apnea-Hypopnea Index (AHI) of 15 or greater, or ii. The patient has an Apnea-Hypopnea Index (AHI) greater than 5 and less than 15 with at least 1 or more of the following: 1. Excessive daytime sleepiness 2. Impaired cognition 3. Mood disorders 4. Insomnia 5. Documented hypertension 6. Ischemic heart disease, significant arrhythmia, or 7. History of stroke d. Moda Health considers a Full-Channel Split-Night Polysomnography the preferred medically indicated test when ALL of the following criteria are met: (Split-night polysomnography, also known as CPAP titration (95811) includes the full-channel sleep study for the diagnosis of OSA during the first half of the study, and CPAP titration during the second half.) (CWQI HCS-0083) i. The polysomnography is performed in an American Academy of Sleep Medicine accredited sleep center. ii. The patient has documented signs and symptoms of OSA as noted in number I.a above.

3 Page 3 of 16 iii. The patient has had a home sleep study with one or more of the following: 1. AHI greater than or equal to 30 or above, or 2. The member has tried and failed AutoPAP and requires in lab sleep study for CPAP titration. iv. The patient has a contraindication that prevents a home study from being performed with 1 or more of the following conditions: 1. Age less than COPD 3. CHF 4. Cognitive impairment (inability to follow simple instructions) 5. Neuromuscular disorder 6. Suspicion of central sleep apnea, parasomnias, or periodic limb movement 7. Oxygen dependence 8. History of cardiac dysrhythmias v. The in-lab sleep study must be supervised and interpreted by a Board Certified Sleep Medicine Specialist. vi. CPAP titration will be performed if the patient demonstrates an AHI of greater than or equal to 15 during the first 2 hours of the study. vii. In the event that both elements are not completed, the documentation submitted with the claim supports the sleep study was performed as a full-night polysomnography (95810). e. Moda Health considers a second in-lab polysomnography that is supervised and interpreted by a Board Certified Sleep Medicine Specialist medically indicated when 1 or more of the following criteria are met: (CWQI HCS-0081) i. The patient was diagnosed with OSA during the first study, however, submitted documentation supports that there was insufficient time to perform the CPAP titration ii. The patient had an AHI greater than 5 and less than or equal to 15 during the first study requiring a second study for CPAP titration. iii. The patient is less than 18 years of age and had a positive split night study, a second in-lab split-night study is medically indicated for CPAP titration f. Multiple Sleep Latency Test (95805) for suspected narcolepsy is medically necessary immediately following a full night polysomnography (95810) for ALL of the following: i. The member has 1 or more of the following indications: 1. Member has tried CPAP or AutoPAP with documented compliance and continues to have excessive daytime sleepiness; or

4 Page 4 of Requested test is part of an evaluation of a patient with excessive daytime sleepiness for suspected narcolepsy versus idiopathic hypersomnia following a normal polysomnogram; and ii. The member has 1 or more of the following symptoms: 1. Cataplexy (ie, sudden weakness or loss of muscle tone not accompanied by loss of consciousness; or 2. Disturbed or fragmented sleep; or 3. Hallucinations with sleep onset (hypnagogic) or upon awakening (hypopompic); or 4. Sleep paralysis g. Moda Health will cover repeat sleep studies for All the following indications: HCS-0082 i. The patient has an established diagnosis of OSA and a repeat sleep study is requested to evaluate 1 or more of the following: 1. Assess efficacy of surgery (including tonsillectomy or upper airway) 2. Assess efficacy oral appliances/devices with a change in symptoms; OR 3. Re-evaluate the diagnosis of OSA and need for continued CPAP if there is a significant weight loss (defined as 10% of body weight) since the most recent sleep study; OR 4. There is a significant change in the patient s symptoms despite documented compliance with ordered treatment or change in risk factors (i.e. worsening heart failure, weight gain greater than 20 percent). II. AutoPap, CPAP, BiPAP or oral appliances are covered with 1 or more of the following: a. If a patient has symptoms of sleep apnea or diagnosis of sleep apnea, lifestyle changes should be recommended (weight loss, avoidance of alcohol or sedative medications, and sleep hygiene recommendations). If a patient has documented Obstructive Sleep Apnea, an AutoPAP, CPAP, BiPAP or oral appliance may be considered for 1 or more of the following: i. Moda Health will cover AutoPAP, CPAP and BiPAP for patients that meet the diagnosis criteria for OSA and 1 or more of the following: 1. The patient has a positive sleep study (home or in-lab study) interpreted by a Board Certified Sleep Medicine Specialist. 2. The patient has an Apnea-Hypopnea Index (AHI) of 15 or greater, or 3. The patient has an Apnea-Hypopnea Index (AHI) greater than 5 and less than 15 with at least one of the following: a. Excessive daytime sleepiness b. Impaired cognition c. Mood disorders

5 Page 5 of 16 d. Insomnia e. Documented hypertension f. Ischemic heart disease, significant arrhythmia, or g. History of stroke ii. For a patient receiving therapy for OSA with a CPAP/AutoPAP unit, continued authorization is contingent on demonstrating compliance within the first 3 months of use as demonstrated by All of the following: 1. Compliance reports from the provider with 1 or more of the following: a. Compliance is demonstrated at 70% of usage greater than 4 hours per day over 30 days; or b. Face-to-face clinical re-evaluation by the treating physician determined that adjustments to the CPAP/AutoPAP trial are needed to address failure to respond to PAP therapy. iii. Moda Health will cover custom-fitted and prefabricated oral appliances, including but not limited to tongue-retaining devices or Mandibular advancement devices (TAP or HPAP), for OSA members who meet ALL of the following criteria. 1. Request is NOT for an Oral appliance for OSA that is available over-thecounter without a prescription as they are not covered. 2. The order for the oral appliance is from a Board Certified physician. 3. Member is intolerant, refuses or has failed CPAP therapy 4. Obstructive sleep apnea diagnosed with a sleep study reviewed by a sleep medicine specialist, and 1 or more of the following: a. Apnea Hypopnea Index (AHI) or Respiratory Disturbance Index (RDI) is greater than 15, or b. Mild to moderate sleep apnea with an Apnea Hypopnea Index (AHI) or RDI greater than 5 and less than 15 with a minimum of 10 events and at least 1 or more of the following: i. Excessive daytime sleepiness with an Epworth Sleepiness Scale score 10 ii. Insomnia iii. Impaired cognition iv. Documented hypertension v. Ischemic heart disease, significant arrhythmia, or vi. History of stroke c. Members with severe sleep apnea with an AHI or RDI of greater than 30 and 1 or more of the following:

6 Page 6 of 16 i. Patient has failed CPAP or AutoPAP with documentation of a three month trial or as an adjunct to CPAP or AutoPAP therapy. ii. The treating physician determines that the use of a PAP device is contraindicated 5. No more than one oral appliance is requested within two years. 6. Request does NOT included advanced imaging studies as they are not covered for oral appliances. This includes but is not limited to All of the following: a. CT scan of the head, face, and/or neck b. MRI of the head, face and/or neck 7. Request is Not for Acoustic Pharyngometry as it is not covered for oral appliance fitting. 8. Device is provided and billed for by a licensed dentist (DDS or DMD) b. The following treatments are considered medically necessary in children with habitual snoring and an apnea index of greater than 1 on a nocturnal polysomnography for 1 or more of the following: i. Adenotonsillectomy ii. CPAP in children for OSA when 1 or more of the following criteria are met 1. Adenotonsillectomy is contraindicated 2. Adenotonsillectomy is delayed 3. Adenotonsillectomy is unsuccessful in relieving symptoms of OSA 4. Failed or contraindicated palate expansion (maxillary distraction) c. Other Respiratory Assist Devices (RAD) will be reviewed on a case-by-case basis by the Moda Health Medical Director for the patients with OSA Respiratory assist devices (RAD) will be covered in appropriate cases with documentation supporting medical necessity such as but not limited to COPD, central apnea, complex apnea, or nocturnal hypoventilation. i. BiPAP-ST (spontaneous-timed), BiPAP Auto-SV, ASV, IVAPS or similar devices with a backup rated intended to counteract ventilator instability such as Cheyne-Stokes, Central Sleep Apnea, and Complex Sleep Apnea demonstrated by central apnea that emerges on CPAP or BiPAP therapy at a rate greater than 5 per hour on setting required for control of obstructive events. ii. BiPAP-ST, AVAPS, IVAPS or similar devices with a backup rate intended to provide non-invasive ventilation assistance during sleep in patient with co-morbid restrictive thoracic disorders or COPD that demonstrates 5 minutes or more of oxygen saturation at 88 percent or less despite correction of the AHI with CPAP/BiPAP.

7 Page 7 of 16 III. All of The following procedures are NOT covered by Moda Health: a. Repose System, a minimally invasive technique involving tongue base suspension, is considered investigational. b. Snoreplasty, an injection of a sclerosing agent into the soft palate, is considered investigational. c. Cardiac Atrial pacing for the treatment of sleep apnea is considered investigational. d. Dental procedures (dentures, bridgework, etc) as treatment for OSA are not covered benefits under Moda Health medical plans. Information to be Submitted with Pre-Authorization Request: 1. History and physical including Epworth Sleepiness Scale results 2. Sleep study interpretation for treatment of OSA. 3. CPAP compliance reports for continued authorization of CPAP 4. Medical records from treating physician documenting the requirements Medicare Reference: NCD: Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA) NCD: Durable Medical Equipment LCD: L28606 Oral Appliances for Obstructive Sleep Apnea LCD: L171 Positive Airway Pressure (PAP) Devices for the of Obstructive Sleep Apnea LCA: A19827 Positive Airway Pressure (PAP) Devices for the of Obstructive Sleep apnea LCA: A50413 Oral Appliances for Obstructive Sleep Apnea CAG-00093N Continuous Positive Airway Pressure (CPAP) therapy for Obstructive Sleep Apnea (OSA) Applicable CPT/HCPC: Note: list may not be all inclusive Computed tomography, maxillofacial area; without contrast material Continuous positive airway pressure ventilation (CPAP), initiation and management Sleep study, unattended, simultaneous recording; heart rate, oxygen

8 Page 8 of 16 saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (eg, by airflow or peripheral arterial tone) Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement) G0398 G0399 G0400 Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist

9 Page 9 of 16 E0470 E0471 E0472 E0485 E0486 E0601 S8262 Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface. Respiratory assist device, bi-level pressure capability, with backup rate feature, used with noninvasive interface. Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with invasive. Oral device/appliance used to reduce upper airway collapsibility, adjustable or nonadjustable, prefabricated, includes fitting and adjustment Oral device/appliance used to reduce upper airway collapsibility, adjustable or nonadjustable, custom fabricated, includes fitting and adjustment CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICE Mandibular orthopedic repositioning device, S8262 Mandibular orthopedic repositioning device, each Applicable ICD-9 Codes: ICD-9 Codes Diagnosis Obesity, unspecified Morbid obesity Obesity hypoventilation syndrome Alcohol induced sleep disorders Drug induced sleep disorders Other dysfunctions of sleep stages or arousal from sleep [parasomnias) Organic insomnia, unspecified Insomnia due to medical condition classified elsewhere Insomnia due to mental disorder Other organic insomnia Organic disorders of excessive somnolence [Organic hypersomnia] Organic sleep apnea Obstructive sleep apnea (adult) (pediatric) Circadian rhythm sleep disorder Organic parasomnia Organic sleep related movement disorders Other organic sleep disorders

10 Page 10 of Paralysis agitans (Parkinson's disease) Amyotrophic lateral sclerosis Generalized nonconvulsive epilepsy without mention of intractable epilepsy Generalized nonconvulsive epilepsy with intractable epilepsy Generalized convulsive epilepsy Narcolepsy Myotonic dystrophy Congestive heart failure Stroke 436 Acute, but ill-defined, cerebrovascular disease Spina Bifida Other convulsions Unspecified sleep disturbance Insomnia with sleep apnea, unspecified Insomnia, unspecified Hypersomnia with sleep apnea, unspecified Hypersomnia, unspecified Disruption of 24 hour sleep wake cycle, unspecified Dysfunctions associated with sleep stages or arousal from sleep Unspecified sleep apnea Sleep related movement disorder, unspecified Other sleep disturbances Other malaise and fatigue Apnea Other dyspnea and respiratory abnormality V85.42-V85.45 BMI greater than 45 Applicable ICD-10 Codes: ICD-10 Codes Diagnosis E66.9 Obesity, unspecified E66.01 Morbid (severe) obesity due to excess calories E66.2 Morbid (severe) obesity with alveolar hypoventilation F Alcohol abuse with alcohol-induced sleep disorder F Alcohol dependence with alcohol-induced sleep disorder F Alcohol use, unspecified with alcohol-induced sleep disorder

11 Page 11 of 16 F Opioid abuse with opioid-induced sleep disorder F Opioid dependence with opioid-induced sleep disorder F Opioid use, unspecified with opioid-induced sleep disorder F Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced sleep disorder F Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced sleep disorder F Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced sleep disorder F Cocaine abuse with cocaine-induced sleep disorder F Cocaine dependence with cocaine-induced sleep disorder F Cocaine use, unspecified with cocaine-induced sleep disorder F Other stimulant abuse with stimulant-induced sleep disorder F Other stimulant dependence with stimulant-induced sleep disorder F Other stimulant use, unspecified with stimulant-induced sleep disorder F Other psychoactive substance abuse with psychoactive substanceinduced sleep disorder F Other psychoactive substance dependence with psychoactive substanceinduced sleep disorder F Other psychoactive substance use, unspecified with psychoactive substance-induced sleep disorder F51.04 Psychophysiologic insomnia F51.05 Insomnia due to other mental disorder F51.8 Other sleep disorders not due to a substance or known physiological condition G12.21 Amyotrophic lateral sclerosis G20 Parkinson's disease G40.A01 Absence epileptic syndrome, not intractable, with status epilepticus G40.A09 Absence epileptic syndrome, not intractable, without status epilepticus G40.A11 Absence epileptic syndrome, intractable, with status epilepticus G40.A19 Absence epileptic syndrome, intractable, without status epilepticus G Generalized idiopathic epilepsy and epileptic syndromes, not intractable, with status epilepticus G Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus G Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus G Other generalized epilepsy and epileptic syndromes, not intractable, with

12 Page 12 of 16 status epilepticus G Other generalized epilepsy and epileptic syndromes, not intractable, without status epilepticus G Other generalized epilepsy and epileptic syndromes, intractable, with status epilepticus G Other generalized epilepsy and epileptic syndromes, intractable, without status epilepticus G Epilepsy, unspecified, intractable, with status epilepticus G Epilepsy, unspecified, intractable, without status epilepticus G47.00 Insomnia, unspecified G47.01 Insomnia due to medical condition G47.09 Other insomnia G47.10 Hypersomnia, unspecified G47.20 Circadian rhythm sleep disorder, unspecified type G47.30 Sleep apnea, unspecified G47.33 Obstructive sleep apnea (adult) (pediatric) G Narcolepsy with cataplexy G Narcolepsy without cataplexy G Narcolepsy in conditions classified elsewhere with cataplexy G Narcolepsy in conditions classified elsewhere without cataplexy G47.8 Other sleep disorders G47.9 Sleep disorder, unspecified G71.11 Myotonic muscular dystrophy G93.3 Postviral fatigue syndrome I50.9 Heart failure, unspecified I Cerebral infarction due to thrombosis of unspecified vertebral artery I Cerebral infarction due to embolism of unspecified vertebral artery I Cerebral infarction due to embolism of unspecified carotid artery I Cerebral infarction due to unspecified occlusion or stenosis of unspecified vertebral arteries I63.20 Cerebral infarction due to unspecified occlusion or stenosis of unspecified precerebral arteries I63.22 Cerebral infarction due to unspecified occlusion or stenosis of basilar arteries I Cerebral infarction due to unspecified occlusion or stenosis of unspecified carotid arteries I63.30 Cerebral infarction due to thrombosis of unspecified cerebral artery

13 Page 13 of 16 I63.40 Cerebral infarction due to embolism of unspecified cerebral artery I63.50 Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery I63.59 Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery I65.09 Occlusion and stenosis of unspecified vertebral artery I65.1 Occlusion and stenosis of basilar artery I65.29 Occlusion and stenosis of unspecified carotid artery I65.8 Occlusion and stenosis of other precerebral arteries I65.9 Occlusion and stenosis of unspecified precerebral artery I66.09 Occlusion and stenosis of unspecified middle cerebral artery I66.19 Occlusion and stenosis of unspecified anterior cerebral artery I66.29 Occlusion and stenosis of unspecified posterior cerebral artery I66.9 Occlusion and stenosis of unspecified cerebral artery I67.89 Other cerebrovascular disease Q05.0 Cervical spina bifida with hydrocephalus Q05.1 Thoracic spina bifida with hydrocephalus Q05.2 Lumbar spina bifida with hydrocephalus Q05.4 Unspecified spina bifida with hydrocephalus Q05.5 Cervical spina bifida without hydrocephalus Q05.6 Thoracic spina bifida without hydrocephalus Q05.7 Lumbar spina bifida without hydrocephalus Q05.8 Sacral spina bifida without hydrocephalus Q07.01 Arnold-Chiari syndrome with spina bifida Q07.03 Arnold-Chiari syndrome with spina bifida and hydrocephalus R86.00 Dyspnea, unspecified R06.09 Other forms of dyspnea R06.3 Periodic breathing R06.81 Apnea, not elsewhere classified R06.83 Snoring R06.89 Other abnormalities of breathing R53.1 Weakness R53.81 Other malaise R53.83 Other fatigue R56.9 Unspecified convulsions Z68.42 Body mass index (BMI) , adult Z68.43 Body mass index (BMI) , adult

14 Page 14 of 16 Z86.44 Body mass index (BMI) , adult Z86.45 Body mass index (BMI) 70 or greater, adult Review Date Revisions Effective Date 01/2013 Annual Review: Added table with review date, revisions, and effective date. Revised criteria for diagnosis of sleep study and repeat sleep study. Added Dr. Engrav s signature instead of Dr. Mills. 01/23/ /2013 Revised the criteria section IV for Split night polysomnography and added section V criteria for a second polysomnography. Removed second sentence from III. Revised number 4 under treatment for other RAD devices removed DPAP/VPAP. 04/2014 Annual review: Removed restless leg syndrome from indications, added change in symptoms for repeat sleep study, added limit of one oral appliance and advanced imaging not covered for oral appliance; added MSLT criteria, revised continuation of CPAP/AutoPAP to meet CMS guideline 04/2015 Annual Review: Added MSLT criteria, revised continuation of CPAP/AutoPAP to meet CMS guideline, added criteria V.a and c for in-lab studies, added criteria VI.c for repeat study less than 18 y/o 06/2015 Included Medicare Reference- added home study section I.b.ii; added ICD-9 and ICD-10 codes 03/1/ /25/ /30/ /24/2015 References:

15 Page 15 of 16 American Academy of Otolaryngology (AAO) Website. Accessed.on January 16, 2013 at: Canadian Agency for Drugs and Technologies in Health (CADTH). Portable monitoring devices for diagnosis of obstructive sleep apnea at home: Review of accuracy, costeffectiveness, guidelines, and coverage in Canada. Ottawa, ON: CADTH; December Accessed on January 16, 2013 at: Kushida, C., Morgnethaler, T., Littner, M., Alessi, C., Bailey, D., et.al. (2006). Practice Parameters for the of Snoring and Obstuctive Sleep Apnea with Oral Appliances: An Update for Sleep, 29(2), Accessed on April 16, 2012 at: Epworth Sleepiness Scale. University of Maryland medical Center. (2011). Accessed on February 25, Friedman M, Ibrahim H, Joseph NJ. Staging of obstructive sleep apnea/hypopnea syndrome: a guide to appropriate treatment. Laryngoscope March; 114(3): Guilleminault C, Abad VC. Obstructive sleep apnea syndromes. Medical Clinics of North America. 2004: 88(3). Haniffa M, Lasserson TJ, Smith I. Interventions to improve compliance with continuous positive airway pressure for obstructive sleep apnoea. Cochrane Database Syst Rev. 2004;(4):CD Hensley N, Ray C. Sleep apnoea. In: BMJ Clinical Evidence. London, UK: BMJ Publishing Group; May McDaid C, Griffin S, Weatherly H, et al. Continuous positive airway pressure devices for the treatment of obstructive sleep apnoea-hypopnoea syndrome: A systematic review and economic analysis. Health Technol Assess. 2009;13(4): Medicare Guidelines for of Obstructive Sleep Apnea. Medicare Part B Policy Ramachandran SK, Josephs LA. A meta-analysis of clinical screening tests for obstructive sleep apnea. Anesthesiology. 2009;110(4): Simantirakis E, Schiza S, Chrysostomakis S, el al. Atrial overdrive pacing for the treatment of obstructive sleep apnea-hypopnea syndrome. N Engl J Med. December 15, 2005; 353(24): Sleep Studies. Medline Plus. Updated January 25, Accessed on January 16, 2013 at: JA. Portable devices for home testing for obstructive sleep apnea. Technology Assessment. San Francisco, CA: California Technology Assessment Forum (CTAF); June 15, Accessed on February 25, 2011 at:

16 Page 16 of 16 Trikalinos TA, Ip S, Raman G, et al. Home diagnosis of obstructive sleep apneahypopnea syndrome. Technology Assessment. Prepared for AHRQ by the Tufts-New England Medical Center Evidence-based Practice Center. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ); August 8, Available at: Accessed on January 16, U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS). Decision memo for continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA) (CAG-0093R2). Medicare Coverage Database. Baltimore, MD: CMS; March 13, 2008 Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991;14: Centers for Medicare & Medicaid Services; National coverage Determination (NCD) for Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep apnea (OSA) (240.4); Publication number Effective date of this Version 3/13/2008; Implementation Date 8/4/2008 Physician Advisors