20-613 Sleep Apnea as a Risk Factor for Your Patients
Date: 08/14/20
This information applies to Physicians, and Participating Physician Groups (PPGs) providers.
For Medi-Cal, this information applies to Kern, Los Angeles, Sacramento, San Diego, San Joaquin, Stanislaus, and Tulare counties.
You can screen and treat sleep disorders to improve health outcomes
Untreated sleep apnea may lead to serious health consequences. Associated health conditions, such as high blood pressure (HBP), heart failure, diabetes, and stroke, can increase your patients’ risk for adverse health outcomes. The major factor for obstructive sleep apnea (OSA) is excess body weight. Providers are the first line of defense to screen and evaluate patients for OSA.
OSA disorders
OSA is characterized by repeated episodes of partial or complete closure of the upper airway that disturbs breathing during sleep. Patients who report snoring, witnessed apneas or daytime sleepiness should be screened for sleep apnea.
OSA risk factors
The American Academy of Sleep Medicine (AASM) recommends1 providers, during routine health exams, use questions that can evaluate patients with the OSA risk factors below.
- Arrhythmia
- HBP and pulmonary hypertension
- Coronary artery disease, heart failure and/or stroke
- Type 2 diabetes mellitus
- Obesity
- Refractory hypertension
Positive findings should prompt a comprehensive sleep evaluation.
Evaluate your patients with screening tools
Some available screening tools include:
- The STOP-Bang questionnaire form and more information can be found on the Stop Bang website.
- Berlin Questionnaire (BQ) form can be found on the American Sleep Apnea Association website.
- The sleep apnea clinical score (SACS) is based on snoring, witnessed apneas, neck circumference, and systemic hypertension. It can calculate the suspected presence of OSA. Those who obtain scores greater than or equal to 15 points have a high probability of OSA. 2
Diagnosis
Having patients attend an in-laboratory sleep study (diagnostic polysomnography) is considered the best diagnosis of OSA. A portable home sleep test may also be used for diagnostic criteria for OSA.
PAP therapy and treatment
The most common form of treatment for OSA is the use of positive airway pressure (PAP). Numerous studies have shown that PAP therapy can decrease the apnea-hypopnea index (AHI) to less than 5 to 10 events/hour in the majority of patients.
Most patients are treated with continuous positive airway pressure (CPAP) therapy.
61% of patients with heart failure have either central or OSA. Sleep apnea:
- Is associated with poor health related quality of life (HRQOL).
- Increases levels of natriuretic peptides.
Treatment may improve cardiac function and decrease pulmonary hypertension for patients. It may also improve blood oxygen levels with a better quality of rest.
Additional information
Providers are encouraged to access Health Net’s provider portal online at provider.healthnet.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact the applicable Health Net Provider Services Center within 60 days at:
Line of Business | Telephone Number | Provider Portal | Email Address |
EnhancedCare PPO (IFP) | 1-844-463-8188 | provider_services@healthnet.com | |
EnhancedCare PPO (SBG) | 1-844-463-8188 | ||
Health Net Employer Group HMO, POS, HSP, PPO, & EPO | 1-800-641-7761 | ||
IFP (CommunityCare HMO, PPO, PureCare HSP, PureCare One EPO) | 1-888-926-2164 | ||
Medicare (individual) | 1-800-929-9224 | ||
Medicare (employer group) | 1-800-929-9224 | ||
Medi-Cal | 1-800-675-6110 | N/A |
1Buman D Sleep Disorder. FP Essent. 2017, 460 1:48
2Flemons WW, Whitelaw WA, Brant R, Remmers JE. Likelihood ratios for a sleep apnea clinical prediction rule. Am J Respir Crit Care Med. 1994;150(5):1279–1285.