ModifiedUnitedHealthcarePolicy CS098NM.C

Sleep Studies (for New Mexico Only)

Medical policy governing coverage and medical necessity criteria for sleep studies (home and attended) for members in New Mexico; applies to diagnostic testing for sleep disorders and related procedures.

Policy Summary

PayerUnitedHealthcare

PolicySleep Studies (for New Mexico Only)

Policy CodePolicy CS098NM.C

Change TypeCoverage criteria revisedHSAT repeat discouragedPSG prior-HSAT timeframe clarified

Effective DateFeb 1, 2026

Next Review DateN/A

Key ActionAfter a single non-diagnostic HSAT (negative, inconclusive, or technically inadequate), proceed to attended full-channel polysomnography rather than repeating HSAT.

SourceLink

POLICY UPDATE CHANGES

Notation that performing a repeat HSAT is not recommended when an initial test is negative, inconclusive, or technically inadequate; after a single such HSAT result, attended full-channel polysomnography is strongly recommended.

Revised coverage criteria for attended full-channel polysomnography for suspected OSA, replacing an older criterion about prior HSAT results with a time-limited requirement referencing HSAT within the past 12 months.

Added notation that repeat HSAT is not recommended when an initial test is negative, inconclusive, or technically inadequate; after a single such HSAT result, attended full-channel polysomnography is strongly recommended.

Revised coverage criteria for attended full-channel polysomnography for suspected OSA to require prior HSAT results within the past 12 months when negative, indeterminate, or technically inadequate.

Revised MSLT criteria to state MSLT is medically necessary for evaluating suspected narcolepsy when other causes of excessive sleepiness have been excluded by appropriate clinical assessment.

Clarified that repeat attended polysomnography and repeat PAP titration are medically necessary for individuals with persistent or new symptoms despite appropriate treatment, and for those with clinically significant weight change (≥ 10%) or changes in cardiovascular disease since last study.

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1State this policy applies to

21+ABP age threshold (no coverage)

>=4hHSAT min monitoring time

BMI>50BMI threshold for PSG

FEV1%<60FEV1% threshold

12 moHSAT recency for PSG

Coverage and Medical Necessity Criteria

Home Sleep Apnea Testing (HSAT) — Initial

Covered when ALL of the following are met for HSAT

HSAT initial indication: HSAT using a portable monitor is medically necessary for evaluating adults with suspected obstructive sleep apnea (OSA).adult

Where HSAT is indicated, APAP may be used to determine fixed PAP pressure. Performing a repeat HSAT is not recommended when an initial test is negative, inconclusive, or technically inadequate; after a single non-diagnostic HSAT, attended full-channel polysomnography is strongly recommended.

Attended Full-Channel Polysomnography — Suspected OSA

Attended full-channel polysomnography is medically necessary in adults suspected of OSA when ANY of the following are present

Attended Polysomnography Indications: Results of previous (within the past 12 months) HSAT are negative, indeterminate, or technically inadequate to make a diagnosis of OSA; or the individual is a child/adolescent (<18 years); or the individual has one or more specified comorbid medical conditions that prohibit the use of HSAT.

Comorbid conditions include significant chronic pulmonary disease (FEV1% predicted < 60), progressive neuromuscular disease, moderate to severe heart failure (NYHA III/IV) or LVEF ≤ 40, BMI > 50, obesity hypoventilation syndrome, ongoing epileptic seizures with sleep disorder symptoms, chronic opiate use > 3 months.

Other Conditions

Attended full-channel polysomnography is medically necessary after clinical assessment for the following conditions

Other Indications for Attended Polysomnography: Periodic Limb Movement Disorder (PLMD); Restless Legs Syndrome not responsive to treatment; parasomnia with disruptive, violent, or potentially injurious sleep behavior suspicious for REM sleep behavior disorder (RBD); narcolepsy once other causes of excessive sleepiness have been excluded by appropriate clinical assessment; central sleep apnea.

Daytime Sleep Studies (MSLT, MWT)

Daytime sleep studies medically necessary conditions

MSLT is medically necessary for evaluating suspected narcolepsy (or idiopathic hypersomnia when other causes of excessive sleepiness have been excluded by appropriate clinical assessment).

Refer to practice parameters; MSLT is not routinely indicated for initial evaluation of OSA.

MWT is medically necessary for adults who are unable to stay awake resulting in a safety issue, or to assess response to treatment in adults with sleep disorders.adult only

MWT is not medically necessary in children <18 years.

PAP Titration and Repeat Testing

Attended PAP titration and repeat testing

PAP Titration: Split-night studies for diagnosis and PAP titration, and full-night attended studies for PAP titration when split-night is inadequate or not feasible in an individual with confirmed OSA, are medically necessary.

Repeat Attended Polysomnography: Repeat attended polysomnography and repeat PAP titration are medically necessary for individuals with persistent, recurrent, or new symptoms despite documented appropriate treatment or PAP therapy, or for individuals with clinically significant weight change (≥ 10%) or changes in cardiovascular disease since the last study.>=10% weight change

Also indicated for equipment/therapy issues (mask fit, pressure leaks, unsuccessful titration).

Diagnostic criteria and testing pathways

Diagnostic criteria and testing pathways described in the document:

OSA diagnostic thresholds: OSA is confirmed if obstructive events on PSG are >15/hour without associated symptoms, or >5/hour in an individual reporting specified symptoms (unintentional sleep episodes, daytime sleepiness, unrefreshing sleep, fatigue, insomnia, witnessed gasping/choking, or partner-reported loud snoring/breathing interruptions).AHI/RDI >15 without symptoms; >5 with symptoms

AASM criteria cited

Testing modality selection: HSAT may be used to diagnose OSA in appropriate uncomplicated adults; PSG remains the in-lab standard. When a portable monitor does not measure sleep, REI is used as a surrogate for AHI. Split-night PSG can combine diagnosis and PAP titration into one night.

Device types (Type 1-4) and indications discussed

HSAT and Attended PSG escalation / Indications

Covered when ALL of the following are met or recommended per guideline:

HSAT negative/inconclusive pathway: If a single HSAT is negative, inconclusive, or technically inadequate, performance of attended full-channel polysomnography is strongly recommended rather than repeating HSAT.single HSAT

Policy revision 02/01/2026 added this requirement; aligned with AASM strong recommendation.

PSG recommended populations: PSG rather than HSAT should be used for diagnosis in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep-related hypoventilation, chronic opioid medication use, history of stroke, or severe insomnia.clinical comorbidity presence

Based on AASM recommendations.

Actigraphy — Covered Uses and Limitations

Actigraphy use per AASM recommendations (conditional/strong):

Actigraphy conditional uses: AASM suggests clinicians use actigraphy to estimate sleep parameters in adults and pediatrics with insomnia disorder; to assess circadian rhythm sleep-wake disorders; integrated with HSAT to estimate total sleep time in adults suspected of sleep-disordered breathing; to monitor total sleep time prior to MSLT; and to estimate total sleep time in suspected insufficient sleep syndrome.conditional

Multiple conditional recommendations from AASM.

Actigraphy not for PLMS diagnosis: AASM recommends clinicians not use actigraphy in place of electromyography for the diagnosis of periodic limb movement disorder (strong).n/a

Strong recommendation

PAP-Nap — Conditional/Investigational Use

PAP-Nap (pilot and retrospective data):

PAP-Nap situational use: PAP-Nap may be considered as a desensitization/adherence intervention for patients refusing full-night attended titration or an in-home PAP trial, but evidence is limited and larger prospective trials are needed.patient refusal/intolerance to standard PAP initiation

Evidence includes a retrospective review (Ulibarri et al., 2020) and a pilot study (Krakow et al., 2008) showing improved initiation and adherence, but further research is required.

MSLT / MWT — Indications

MSLT/MWT indications per AASM practice parameters:

MSLT primary indication: MSLT is indicated as part of the evaluation for suspected narcolepsy to confirm diagnosis.suspected narcolepsy

Practice parameter guidance (AASM).

MSLT other indications: MSLT may help differentiate idiopathic hypersomnia from narcolepsy and may be repeated when initial test conditions were inadequate, ambiguous, or to seek confirmation when suspicion remains despite prior negative testing.specific circumstances

Repeat MSLT indicated in situations such as extraneous circumstances or ambiguous findings.

Updated coverage criteria

Key coverage criteria and logic updates:

HSAT non-diagnostic pathway: If an initial HSAT is negative, inconclusive, or technically inadequate, performing a repeat HSAT is not recommended; after a single non-diagnostic HSAT, attended full-channel polysomnography is strongly recommended.

Added in 02/01/2026 revision.

Attended polysomnography prior HSAT requirement: For suspected OSA, criteria for attended full-channel polysomnography were revised to reference results of a previous HSAT within the past 12 months when negative, indeterminate, or technically inadequate.HSAT within 12 months

Replaced prior broader wording.

MSLT for suspected narcolepsy: MSLT is medically necessary for evaluating suspected narcolepsy when other causes of excessive sleepiness have been excluded by appropriate clinical assessment.

Language revised to remove broader prior wording and InterQual reference.

Attended full-channel polysomnography and actigraphy are considered not medically necessary for evaluation of circadian rhythm disorders, depression, and insomnia. The policy lists these uses among studies judged to lack sufficient evidence of efficacy and therefore excluded from coverage under the standard criteria.

Current evidence assessing actigraphy as a diagnostic tool is limited and does not establish actigraphy as a stand-alone diagnostic test for sleep disorders. Systematic reviews and evidence assessments note small, heterogeneous studies with inconsistent findings and risk of bias, and conclude that available data are insufficient to validate actigraphy as an adjunct or alternative to conventional sleep testing for central hypersomnolence, insomnia, or obstructive sleep apnea.

Actigraphy should not be used in place of electromyography for diagnosing periodic limb movement disorder. The AASM issues a strong recommendation against substituting actigraphy for electromyography, and systematic reviews highlight technical variability and insufficient accuracy of leg actigraphy for PLMS detection.

Performing a repeat HSAT after a single negative, inconclusive, or technically inadequate HSAT is not recommended. Policy revision clarifies that because a second unattended study is likely to provide a similarly non-diagnostic result, the recommended next step after one non-diagnostic HSAT is escalation to an attended full-channel polysomnography.

If federal, state, or contractual benefit plan coverage differs from this Medical Policy, those federal, state, or contractual requirements take precedence. The policy instructs providers to check applicable plan terms and legal requirements before applying the standard policy guidance.

Abbreviated daytime sleep studies (for example, PAP-Nap) are considered not medically necessary due to insufficient evidence of efficacy. Additionally, the Maintenance of Wakefulness Test (MWT) is not medically necessary in children and adolescents under 18 years; MWT retains limited, age‑specific indications in adults only.

Use of actigraphy as a stand-alone diagnostic test for narcolepsy, central disorders of hypersomnolence, insomnia, or obstructive sleep apnea is not supported by sufficient evidence. Reviews and guideline statements indicate conditional roles for actigraphy in specific contexts but do not endorse it as an independent diagnostic modality for these disorders.

Routine performance of more than a single night's HSAT recording is not supported by current evidence and is not recommended as standard practice. When an initial HSAT is negative, inconclusive, or technically inadequate, repeating the HSAT is discouraged and escalation to attended polysomnography is advised.

Repeat HSAT is discouraged because a second unattended study is likely to be negative, inconclusive, or technically inadequate as well. The guidance is to proceed to an attended full-channel polysomnography after a single non-diagnostic HSAT rather than ordering a repeat home study.

Coding and Billing References

Referenced CPT Codes (subset)CPT

95782	Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist.
95783	Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist.
95800	Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time.
95801	Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone).
95803	Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording).
95805	Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness.
95806	Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoracoabdominal movement).
95807	Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist.
95808	Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist.

Referenced CPT and HCPCS Codes (additional)mixed

95810	Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist.
95811	Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist.
G0398	Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation.
G0399	Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation.
G0400	Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels.

PAP-Nap CPT exampleCPT

95807-52

Daytime, abbreviated cardio-respiratory sleep study (PAP-Nap) (as cited in Krakow)

inv-24: HSAT minimum monitoring time — >= 4 hours

Minimum monitoring time>= 4 hours of monitoring time recorded (adequate HSAT requires a minimum of four hours)

Required sensors (minimum)Nasal pressure, chest and abdominal respiratory inductance plethysmography, and oximetry

Test settingUnattended diagnostic study (often performed at home) without determination of sleep stage

inv-25: Obesity Hypoventilation Syndrome BMI threshold — BMI >= 30 kg/m2; BMI > 50 as indication for attended polysomnography

OHS BMI definitionBMI >= 30 kg/m2 (Obesity Hypoventilation Syndrome requires obesity with daytime hypercapnia)

Provider Steps, Documentation, and Prior Authorization Notes

Prior Authorization

HSAT-to-PSG escalation

When an initial HSAT (home sleep apnea test) is negative, inconclusive, or technically inadequate, performing a repeat HSAT is not recommended. After a single non-diagnostic HSAT, attended full‑channel polysomnography (PSG) is strongly recommended as the next step rather than repeating HSAT. HSAT is the preferred initial diagnostic test for uncomplicated adults with suspected obstructive sleep apnea (OSA); however, attended PSG is required when prior HSAT within the past 12 months is non‑diagnostic or when clinical factors (e.g., pediatric patients, significant cardiorespiratory disease, neuromuscular disease, suspected hypoventilation, chronic opioid use, BMI >50, progressive neurologic disease, significant heart failure, ongoing seizures) preclude accurate HSAT interpretation.

After one negative, inconclusive, or technically inadequate HSAT → do not repeat HSAT; proceed to attended full‑channel PSG.
HSAT is preferred initial test for uncomplicated adults; attended PSG required if HSAT within prior 12 months is non‑diagnostic or other exclusion criteria are present.

Definitions and Test Descriptions

inv-51: Home Sleep Apnea Testing (HSAT) — Unattended diagnostic studies to assess for OSA; adequate HSAT requires minimum monitoring time and other operational elements.

DefinitionUnattended diagnostic studies to assess for obstructive sleep apnea without determination of sleep stage (often performed at home)

Adequacy requirementsAdequate HSAT requires minimum monitoring time of >= 4 hours and minimum sensors: nasal pressure, chest and abdominal respiratory inductance plethysmography, and oximetry

Limitations and escalationHSAT may yield negative, inconclusive, or technically inadequate results; after a single non-diagnostic HSAT, attended full-channel polysomnography is strongly recommended

inv-52: Multiple Sleep Latency Test (MSLT) — Daytime sleep study measuring physiological sleep tendency under standardized conditions used for suspected narcolepsy.

PurposeDaytime sleep study measuring physiological sleep tendency under standardized conditions

Background and Evidence Summary

Background: Home Sleep Apnea Testing (HSAT) is an option to evaluate adults with suspected obstructive sleep apnea (OSA) in appropriate uncomplicated patients. Attended full‑channel polysomnography remains the in-lab standard and is required for children, for patients with certain comorbidities that preclude reliable HSAT, and when HSAT results are negative, inconclusive, or technically inadequate.

Policy Changes and Revision History

2026-02-01material_updateLatest

Revised coverage criteria to add that performing a repeat HSAT after a single negative, inconclusive, or technically inadequate HSAT is not recommended and that attended full-channel polysomnography is strongly recommended instead; revised attended PSG criteria to require prior HSAT results within the past 12 months when negative/indeterminate/technically inadequate.

Policy change note: The 02/01/2026 revision explicitly added language about HSAT recency and discourages repeating HSAT after a single non-diagnostic study. Specifically, the policy notes that a single negative, inconclusive, or technically inadequate HSAT should prompt attended PSG rather than repeat HSAT, and prior HSAT results cited in PSG criteria are specified as being within the past 12 months.

Policy Summary

PayerUnitedHealthcare

PolicySleep Studies (for New Mexico Only)

Policy CodePolicy CS098NM.C

Change TypeCoverage criteria revisedHSAT repeat discouragedPSG prior-HSAT timeframe clarified

Effective DateFeb 1, 2026

Next Review DateN/A

Key ActionAfter a single non-diagnostic HSAT (negative, inconclusive, or technically inadequate), proceed to attended full-channel polysomnography rather than repeating HSAT.

SourceLink

On This Page

Repeat attended polysomnography or PAP titration: Repeat attended full-channel polysomnography and repeat PAP titration are medically necessary for individuals with persistent or new symptoms despite appropriate treatment or PAP therapy, or for individuals with clinically significant weight change (≥ 10%) or changes in cardiovascular disease since the last study.>=10% weight change

Added weight and cardiovascular change criteria in revision.

Indication for attended PSG

BMI > 50 is listed as a comorbid condition that prohibits HSAT and indicates attended polysomnography

Associated physiologic criterionDaytime hypercapnia (arterial PaCO2 >= 45 mmHg) when present supports OHS diagnosis

inv-26: Chronic Pulmonary Disease severity threshold — FEV1% predicted < 60

Chronic pulmonary disease severity thresholdFEV1 % predicted < 60 (i.e., Moderately Severe or worse) — this degree of impairment prohibits HSAT and indicates attended PSG

Severity categories contextFEV1% predicted: Moderate 60-69; Moderately Severe 50-59; Severe 35-49; Very Severe <35

Source guidanceListed among comorbid conditions that prohibit use of HSAT for suspected OSA

inv-27: OSA severity — Mild/Moderate/Severe AHI/RDI thresholds

Mild OSAAHI or RDI ≥ 5 and < 15 events/hour

Moderate OSAAHI or RDI ≥ 15 and ≤ 30 events/hour

Severe OSAAHI or RDI > 30 events/hour

inv-28: Clinically significant weight change — >= 10%

Clinically significant weight change>= 10% change in body weight since the last study may justify repeat attended PSG or PAP titration

Use caseApplies to repeat testing decisions for persistent/new symptoms or therapy reassessment

DocumentationWeight-change must be documented in the medical record to support repeat testing

inv-29: HSAT recency for attended polysomnography consideration — within the past 12 months

HSAT recency requirementResults of a previous HSAT must be within the past 12 months when used to justify attended PSG for suspected OSA

ContextRevised coverage criteria specify prior HSAT within 12 months if results are negative, indeterminate, or technically inadequate

Operational implicationA prior HSAT older than 12 months should not be relied upon for PSG decision per this policy revision

Billing Rule

Coding inclusion is not coverage

Do not assume inclusion of a CPT or HCPCS code in this policy means a service is covered or payable. Code lists are provided for reference only. Benefit coverage and reimbursement are determined by the member’s federal, state, or contractual benefit plan and applicable laws. Always confirm coverage and prior authorization requirements with the applicable contract.

Listing of procedure or diagnosis codes is informational and not a guarantee of coverage or payment.
Verify benefit plan and contract terms before performing or billing services.

Note

Plan-specific requirements govern

Benefit coverage decisions must reference and follow federal, state, and contractual plan requirements. If this policy conflicts with a member’s federal, state, or contractual benefit terms, those terms govern. Before applying this policy, check the member’s specific plan and any regulatory requirements.

Plan, state, or federal requirements override this policy in the event of conflict.
Check contract and regulatory terms prior to authorization or scheduling.

Documentation Required

Medical records documentation requirements and OSA diagnostic thresholds

The patient's medical record must fully document the clinical rationale for testing and any subsequent studies. Documentation should include relevant medical history, focused physical examination findings, symptoms supporting OSA (for example, excessive daytime sleepiness, witnessed apneas, gasping/choking, impaired cognition), results of prior diagnostic tests, and details of prior HSAT and PSG (dates, results, and technical adequacy). Diagnosing OSA should follow AASM thresholds: an apnea‑hypopnea index (AHI) >15 events/hour supports OSA diagnosis even without listed symptoms; an AHI ≥5 events/hour supports diagnosis when accompanied by symptoms such as daytime sleepiness, witnessed apneas, or hypertension. Lack of adequate documentation may lead to denial of the requested service.

Medical record must include relevant history, physical exam, and prior test results to support medical necessity.
Document AHI and whether diagnostic thresholds are met: >15 events/hour (without symptoms) or ≥5 events/hour (with symptoms).
Record dates and adequacy of prior HSAT/PSG; indicate why attended PSG is required when applicable.

Note

PAP‑Nap as adherence intervention

PAP‑Nap testing may be considered as an adherence‑enhancement intervention for selected patients who are reluctant to undergo full‑night attended titration or who have difficulty initiating PAP therapy. Evidence is limited (pilot data) and further large, prospective studies are needed; use of PAP‑Nap should be individualized and accompanied by documentation of rationale and expected benefit.

PAP‑Nap can be used for desensitization and to improve subsequent adherence to PAP in selected patients refusing full‑night titration or home PAP trial.
Because evidence is limited, document the clinical rationale and expected adherence goals when using PAP‑Nap.

Primary indicationMedically necessary for evaluating suspected narcolepsy after exclusion of other causes of excessive sleepiness

Typical useMultiple trials conducted during the day to assess sleep latency (MSLT)

inv-53: Maintenance of Wakefulness Test (MWT) — Daytime sleep study measuring ability to stay awake; used for safety assessments or treatment response.

PurposeDaytime sleep study that measures the ability to stay awake in nonstimulating conditions

Clinical usesUsed for safety assessments or to assess response to treatment in adults with excessive sleepiness

Age limitationMWT is not medically necessary in children < 18 years

inv-54: OSA — Obstructive Sleep Apnea definition summary.

Definition summaryObstructive Sleep Apnea (OSA) is a sleep-related breathing disorder with decreased or halted airflow despite continued respiratory effort

Diagnostic thresholdsOSA is confirmed if obstructive events >15/hour without symptoms, or >5/hour with specified symptoms (events reported as AHI or RDI)

Severity classificationMild: AHI/RDI ≥5 and <15; Moderate: ≥15 and ≤30; Severe: >30/hour

inv-55: OHS — Obesity Hypoventilation Syndrome definition (BMI threshold, daytime hypercapnia).

DefinitionObesity Hypoventilation Syndrome (OHS) is obesity (BMI ≥ 30 kg/m2) with daytime hypercapnia (PaCO2 ≥ 45 mmHg) not fully explained by cardiopulmonary or neurologic disease

Related PSG indicationOHS is listed among comorbid conditions that prohibit HSAT and indicate attended polysomnography

inv-56: Attended PSG — Polysomnogram (Attended) — laboratory-based multi-channel study description.

DescriptionPolysomnogram (Attended) is a laboratory-based multi-channel sleep study recording brain activity, eye movements, body movements, breathing and heart rate with a technologist present

UsesStandard diagnostic test for OSA and can combine diagnosis with PAP titration in split-night studies

inv-57: REI — Respiratory Event Index — used with HSAT; events per hour divided by monitoring time.

DefinitionRespiratory Event Index (REI) is the total number of respiratory events during the entire sleeping period times 60 divided by monitoring time (events/hour)

Use with HSATREI is used with HSAT as a surrogate for AHI when sleep is not measured

Reporting unitsReported as events per hour, analogous to AHI or RDI

inv-58: PAP-Nap — Definition: Daytime abbreviated cardio-respiratory exposure session (~100 minutes) combining desensitization and behavioral components.

DefinitionPAP-Nap is a daytime, abbreviated cardio-respiratory exposure session (~100 minutes) combining desensitization, psychological strategies, and physiological exposure to PAP

Intended purposeUsed to improve PAP tolerance/adherence in patients anxious or intolerant of full-night PAP initiation

inv-59: Actigraphy — Wrist- or leg-worn accelerometer to estimate sleep parameters; conditional use per AASM.

DefinitionActigraphy is a wrist- or leg-worn accelerometer used to estimate sleep parameters and total sleep time

Recommended usesAASM suggests conditional use for insomnia, circadian rhythm disorders, integration with HSAT to estimate total sleep time, and monitoring prior to MSLT

LimitationsActigraphy should not be used in place of electromyography for diagnosis of periodic limb movement disorder

inv-60: MSLT/MWT — Definitions and typical clinical uses for excessive sleepiness evaluation.

MSLT purposeMSLT and MWT are daytime tests used to evaluate excessive sleepiness; MSLT is indicated for narcolepsy diagnosis

MWT purposeMWT assesses ability to stay awake and can be used for safety assessments or to assess treatment response

Testing contextMSLT is not routinely indicated for initial OSA evaluation but is used when excessive sleepiness persists despite treatment

inv-61: HSAT — Summary: acceptable for diagnosing OSA in appropriate uncomplicated patients; a single non-diagnostic HSAT should prompt attended PSG.

HSAT appropriatenessHSAT is acceptable for diagnosing OSA in appropriate uncomplicated patients when performed with a technically adequate device

Non-diagnostic HSAT actionA single negative, inconclusive, or technically inadequate HSAT should prompt attended full-channel polysomnography rather than repeating HSAT

LimitationsHSAT is less sensitive than PSG and may yield false negatives; multiple-night HSAT evidence is insufficient to recommend routine multi-night testing

inv-62: Multiple Sleep Latency Testing (MSLT) — MSLT is medically necessary for evaluating suspected narcolepsy when other causes have been excluded.

MSLT medical necessityMSLT is medically necessary for evaluating suspected narcolepsy when other causes of excessive sleepiness have been excluded by appropriate clinical assessment

Role in differential diagnosisMSLT may help differentiate idiopathic hypersomnia from narcolepsy

Testing limitationsMSLT is not routinely indicated for initial OSA evaluation or most other disorders causing sleepiness

inv-63: Home Sleep Apnea Testing (HSAT) — HSAT may yield negative, inconclusive, or technically inadequate results; a single such non-diagnostic HSAT should prompt attended PSG.

Potential HSAT outcomesHSAT may yield negative, inconclusive, or technically inadequate results

Recommended escalationAfter a single non-diagnostic HSAT, attended full-channel polysomnography is strongly recommended rather than repeating HSAT

RationaleA second HSAT is likely to also be negative, inconclusive, or technically inadequate and may delay definitive diagnosis