Publication date: 2018-11-05 12:30
For patients with progressive neuromuscular disorders, the consensus panel concluded that pulmonary function test results may be an additional indicator of nocturnal de-saturation. Most amyotrophic lateral sclerosis patients have a forced vital capacity (FVC) below 55 % predicted before either the physician or patient actually becomes aware of any respiratory system involvement. Other measurements like maximal inspiratory pressure with a magnitude less than 65 cm H 7 O have been shown to be highly sensitive albeit less specific indicator of nocturnal de-saturation.
Aetna considers single-breath nitrogen testing (also known as single-breath oxygen testing) experimental and investigational because the value of this test in the management of persons with pulmonary disorders/diseases has not been established. Single-breath tests for determining airway closure volume that are performed using other tracer gases such as xenon, argon, or helium are also considered experimental and investigational because of insufficient evidence in the peer-reviewed literature.
With respect to simple tonsillectomy as a treatment for adult OSA, updates to the American Academy of Sleep Medicine practice parameters for the treatment of OSA state that classic upper airway surgical techniques such as nasal-septal reconstruction, cauterization, and tonsillectomy frequently fail to correct OSA (Aurora et al, 7565).
Aetna considers tongue base reduction surgery experimental and investigational for the treatment of OSA because its effectiveness has not been established.
An UpToDate review on "Tracheomalacia and tracheobronchomalacia in adults" (Ernst et al, 7567) states that "[c]ontinuous positive airway pressure (CPAP) can maintain an open airway and facilitate secretion drainage. This is often initiated in the hospital during an acute illness. The patient initially receives continuous CPAP and is gradually transitioned to intermittent CPAP as tolerated. Patients may use intermittent CPAP as long-term therapy. However, CPAP does not appear to have a long-term impact on dyspnea or cough. Positive airway pressure other than CPAP (., bilevel positive airway pressure) may be used instead if hypercapnic respiratory failure exists".
Laser-assisted uvulopalatoplasty (LAUP) is an outpatient surgical procedure, which has been used as a treatment for snoring. LAUP has also been used as a treatment for sleep-related breathing disorders, including obstructive sleep apnea. The American Academy of Sleep Medicine Standards of Practice Committee reviewed the evidence supporting the use of LAUP in obstructive sleep apnea, and found that adequate controlled studies on the LAUP procedure for sleep-related breathing disorders were not found in the peer-reviewed literature (Littner et al, 7556). The AASM concluded that "LAUP is not recommended for treatment of sleep-related breathing disorders."
Aetna considers genioplasty and genial tubercle advancement for the treatment of adult OSA esperimental and investigational because of insufficient evidence in the peer-reviewed published medical literature of its safety and effectiveness.
Aetna considers the Advance System (an adjustable tongue-advancement device) experimental and investigational for the treatment of OSA because its effectiveness has not been established.
The Provent sleep apnea therapy is a non-invasive treatment for OSA. The Provent nasal device uses a novel MicroValve design that attaches over the nostrils and is secured in place with hypo-allergenic adhesive. The MicroValve opens and closes, redirecting air through small holes to create resistance upon breathing out.
Aetna considers the use of remotely controlled mandibular positioner as a predictive screening tool for oral appliances that protrude the mandible experimental and investigational because of insufficient evidence in the peer-reviewed published medical literature of its safety and effectiveness.