Blue Cross of Idaho has issued a positive coverage policy of Inspire Medical Systems Inc’s Inspire upper airway stimulation therapy for obstructive sleep apnea. This is the first coverage policy issued following BCBS Evidence Street’s January 7, 2019 report, which stated there is sufficient evidence to determine that Inspire therapy results in a meaningful improvement in net health outcomes for patients meeting specified criteria.

Blue Cross of Idaho is a not-for-profit mutual insurance company covering approximately 500,000 members. Blue Cross of Idaho is an independent licensee of the Blue Cross and Blue Shield Association (BCBSA). The Blue Cross of Idaho policy is effective March 20, 2019. This policy has a few changes from the Evidence Street summary including a BMI of less than 32. This Blue Cross of Idaho is the first policy to include coverage for adolescents who have Down’s syndrome. It is important to note that this indication is not yet approved by the FDA.

In addition to Blue Cross of Idaho, an additional positive coverage policy became effective January 1, 2019 with Ascension Smart Health. These

…

People who sleep less than 6 hours a night may be at increased risk of cardiovascular disease compared with those who sleep between 7 and 8 hours, suggests a new study published in the Journal of the American College of Cardiology. Poor quality sleep increases the risk of atherosclerosis—plaque buildup in the arteries throughout the body—according to the study.

“Cardiovascular disease is a major global problem, and we are preventing and treating it using several approaches, including pharmaceuticals, physical activity, and diet. But this study emphasizes we have to include sleep as one of the weapons we use to fight heart disease—a factor we are compromising every day,” says senior study author José M. Ordovás, PhD, researcher at the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC) in Madrid and director of nutrition and genomics at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, in a release. “This is the first study to show that objectively measured sleep is independently associated with atherosclerosis throughout the body, not just in the heart.”

Previous studies have

…

Obstructive sleep apnea is a chronic condition, yet many clinicians and patients focus on the first 90 days. Some stakeholders envision years-long followup that considers the dynamic nature of the sleep disorder.

By Sree Roy

The vast majority of obstructive sleep apnea (OSA) cases require a lifetime of management to control—similar to other chronic disorders such as hypertension and diabetes. But the care pathway for many OSA patients more closely resembles that of people with surgical diseases such as appendicitis or cataracts: A flurry of activity until diagnosis, a sense of urgency to implement a therapy, then short-term followup.

Sleep apnea care focuses on the first 90 days. This is a reflection of factors such as payor requirements (notably, Medicare’s CPAP compliance guideline stating it won’t pay for continued therapy without adherence in that time frame), studies showing patients’ initial therapy usage informs later usage, and time constraints on sleep professionals.

But the emphasis on those first 90 days coupled with less focus on optimizing long-term care has its consequences. Some patients are shortchanged of lifelong symptom abatement and comorbidity

…

An observant sleep medicine physician approached the school with a pitch: expose third- and fourth-year students to the sleep subspecialty.

By Lisa Spear

Medical school curriculums generally don’t take a deep dive into sleep medicine. Some medical students may not even realize they have the option to subspecialize in sleep. This gap in education may be fueling a shortage of sleep medicine physicians.

Some medical schools are taking steps to change that. The University of North Carolina (UNC) in Ashville, NC, recently appointed Muhammad Sayed, MD, RST, RPSGT, to develop a sleep medicine curriculum in his new role as an assistant professor.

Through this program, third- and fourth-year students will have the opportunity to do rotations at the Charles George VA Medical Center in Asheville, NC, part of the US Department of Veterans Affairs. This is where Sayed will continue to work as chief of sleep medicine while he supervises the UNC program.

Sayed will spend time working one-on-one with students and giving lectures on campus. He hopes that through this initiative more future physicians will be exposed to and

…

A Diplomate walks those less familiar with the process step-by-step through oral appliance therapy.

By Jeff Rodgers, DMD, DABDSM, DASBA

Oral appliance therapy (OAT) provides an alternative treatment option for those with upper airway resistance syndrome and obstructive sleep apnea (OSA). The patient’s treatment journey begins with the referring physician, who will have administered a sleep test, and, either due to the patient’s noncompliance with CPAP or the patient’s preference, sends the patient to a dental sleep medicine practitioner for an oral appliance.

The dentist’s job in properly treating a sleep apnea patient with an oral appliance involves a set of processes that are undertaken with the goal of identifying the patient’s specific needs, the condition of their mouth and throat, and their systemic health. Once the patient has been thoroughly evaluated, the appropriate device can be selected and fitted, allowing the patient to begin their treatment and follow-up.

Outlined here is the standard process used in my office to guide the patient from initial consultation to successful treatment. While each dentist runs their office slightly differently, this patient journey

…

A columnist for the Orlando Sentinel describes visiting the the doctor’s office for a stomach issue when he learned that he may have sleep apnea.

Doctors investigating minor stomach trouble insisted that your local columnist undergo a quick test in which they knock you out and stick cameras down your throat to maraud around in the murky squishiness of what one might call the upper guts. One question they asked first: Have you ever been diagnosed with sleep apnea? No, I said, I haven’t.

Just as I came to, coughing and choking, being wheeled on a gurney down a hall at Advent Health, the doctor demanded, “I thought you said you didn’t have sleep apnea?” Gathering my wits, I retorted that she’d asked whether I’d been diagnosed with sleep apnea. Different question. Different answer.

This obstructive sleep apnea condition is quite common but insidious. The most prevalent sort occurs when the soft tissue collapses at the back of the throat, slamming shut the sleeper’s airway. Typically, the brain arouses the sleeper with a pointed instruction to keep breathing.

Get the

…

Inspire Medical Systems Inc, a medical technology company that makes an implantable therapy for obstructive sleep apnea (OSA) and is focused on the development and commercialization of minimally invasive solutions for patients with the sleep disorder, reports that the Blue Cross Blue Shield Association’s (BCBSA) Evidence Street issued a positive assessment of Inspire therapy to its members. BCBSA is a national federation of 36 Blue Cross and Blue Shield (BCBS) companies.

The report summarized that sufficient evidence exists to determine that hypoglossal nerve stimulation results in a meaningful improvement in the net health outcome for patients meeting the following selection criteria, which are based on information from clinical study populations and clinical expert opinion:

• age ≥ 22 years in adults, or adolescents with Down’s syndrome (age 10 to 21 years); and
• diagnosed moderate to severe OSA (with less than 25% central apneas); and
• CPAP failure or inability to tolerate CPAP; and
• body mass index ≤ 35 kg/m2 in adults; and
• favorable pattern of palatal collapse.

“This positive assessment demonstrates the strength of the clinical evidence for Inspire therapy and is

…

A new CPAP user has trouble with the device “pumping forced air into [her] stomach,” reports the Orlando Sentinel.

On the other hand, this user’s nocturnal musings about the machine would be far more kindly if the humidifier were filled nightly with Cabernet.

Read the full commentary at orlandosentinel.com