DaytonDailyNews.com

Medicare, Medicaid to vote on wider coverage for sleep apnea

WASHINGTON — Peter Rosi stopped breathing 84 times in an hour.

Wired from head to toe in the Jupiter Medical Center's Sleep Lab in Florida, Rosi was diagnosed with obstructive sleep apnea, a potentially fatal condition resulting from the collapse of an airway during sleep.

(enlarge photo) Peter Rosi UMA SANGHVI (enlarge photo) Sleep apnea patient Peter Rosi wears this continuous positive airway pressure machine so he does not stop breathing at night.

Since his diagnosis five years ago, Rosi says he feels better. He has been using a breathing device that delivers air through a fitted mask, a treatment known as continuous positive airway pressure.

Rosi, 62, experienced only mild symptoms such as snoring and daytime sleepiness. But sleep apnea can also cause congestive heart failure, cardiac arrhythmias, and stroke.

According to the Journal of the American Medical Association, one in five adults has at least mild sleep apnea. Treatment for the condition is covered by the Center for Medicare and Medicaid Services covers when patients are diagnosed in sleep labs.

Currently, treatment is not covered for Medicare and Medicaid patients diagnosed by less comprehensive tests in their homes. But in March, CMS will vote to change that policy.

Not everyone is in favor of the change.

"Home sleep monitoring on some machines doesn't monitor sleep at all, and that is already a misconstrued piece. Whoever interprets the test has to understand what they are looking for," said Dr. Joyce Walsleben, a sleep specialist at New York University Medical Center.

Doctors in favor of the policy change say it would provide patients the screening they need.

"My experience has been that it's hard to get patients into sleep labs. Anything that helps raise awareness and fix sleep problems will have a positive impact," said Dr. Lee Goldberg, a cardiologist at the Hospital of the University of Pennsylvania.

Walsleben acknowledged that intimidation keeps some patients from going to a sleep lab, but added, "At some point you have to say, I need a specialist and head off."

Before his diagnosis, Rosi said, "I was just lying to myself." Learning of his condition "wasn't a big deal, no surprises," he said. "People who are diagnosed have a sense that something is wrong."

Rosi said he feels that the best way to diagnose a patient is under lab conditions.

"It's a regular bedroom," he said of the sleep center. "It's not a hospital setting. There is a camera on you, you're wired head to toe and they know even when you are dreaming. It was a pleasant experience. I didn't feel uncomfortable."

Rosi's diagnosis and subsequent treatment has allowed him to get six to seven full hours of sleep each night.

"I feel rested in the morning," he said. "I enjoy what I do and seeing wonderful people. It gives me a reason to get out of bed every morning."