Mom2sleepyson wrote:My teenage son recently had a sleep study. He only had one OSA, but had a lot of hypopneas. The sleep doctor is recommending we see an ENT to evaluate surgical options for two reasons: 1) she says teens won't wear CPAPs, and 2) she says insurance won't pay for a CPAP with just hypopneas. It doesn't seem to make a lot of sense to me that insurance would pay for surgery, which it seems should cost more and have a higher risk, but not pay for a CPAP. We do have an appointment with an ENT for an evaluation, but the sleep doctor is also trying to get us a trial run on a loaner CPAP at my insistence. My son is exhausted all of the time, and his quality of life and education are really suffering. Has anybody had success in treating hypopneas with a CPAP or surgery? Was it covered by insurance?
While the question of whether a teen will sleep with a CPAP depends on the teen, insurance companies will CLEARLY pay for CPAP machines when the AHI is made up entirely of hypopneas. Contact your insurance company and ask if you don't believe me.
Now it is true that Medicare (and maybe Medicaid) and some private insurance companies require that the hypopneas be scored under something called the AASM AHI_Recommended standard instead of the AASM AHI_Alternative standard. Here are the two different standards:
AASM AHI_Recommended standard: Hypopneas are required to have ≥ 30% airflow reduction that lasts at least 10 seconds and ≥ 4% desaturation.
AASM AHI_Alternative standard: Hypopneas are required to have ≥ 50% airflow reduction that lasts at least 10 seconds and (either a ≥ 3% desaturation or an arousal)
Labs are supposed to indicate which standard they are using when scoring sleep studies. It's important to realize that in the AHI_Alternative standard, the hypopnea does NOT need to have an accompanying desaturation IF the reduction in airflow is sufficiently great and there's an arousal present in the EEG. These "hypopneas with arousal (but no desaturation)" cannot be counted as an hypopnea under the AHI_recommended no matter how much the air flow is decreased and no matter how long the decreased air flow lasts before the arousal.
So there's a remote chance that you could have problems with the insurance company if they insist that the hypopneas be scored under the AASM AHI_Recommended standard and the vast majority of your son's events were "hypopneas with arousal (but no desaturation)" that were scored under the AASM_Alternative standard.
If you haven't already done it, ask for a copy of the sleep study report complete with ALL the summary graphs and summary information.
Finally, regardless of the definition of "hypopnea" used to score the sleep study, CPAP is considered the gold standard treatment for people with OSA even when all of the events are hypopneas instead of apneas. It's highly effective (for those who sleep with it EVERY NIGHT, ALL NIGHT LONG), is non-invasive, and uses a benign substance (slightly pressurized room air) to prop the upper airway open. The real problem with CPAP therapy is compliance---i.e. sticking with the therapy long enough to work out comfort issues that are present at the beginning when the idea of sleeping with a hose on your nose seems overwhelming. And there are a lot of things to get used to. And in the short run, some people have major problems with aerophagia and insomnia issues and feel as though they slept better without the mask than they do with the mask. These problems CAN be overcome with patient education and support and by a patient who is willing to WORK at making the therapy work instead of expecting instant gratification in terms of relief of daytime sypmtoms.
Best of luck to your son.