What if patients who need CPAP do not qualify for insurance coverage?
There are some patients who benefit from CPAP for sleep-disordered breathing, but who do not meet the Medicare or private insurer coverage criteria. For example, some patients have very frequent arousals because of increased breathing effort, but do not have desaturations. Those patients will have a high respiratory disturbance index (RDI), but they may have a low number of apneas and hypopneas – their apnea/hypopnea index (AHI) will be low. Patients with upper respiratory resistance syndrome (URRS) – a type of sleep-disordered breathing – have a low AHI and also may have a low RDI. On CPAP these patients may have very significant improvement in sleep continuity and in alertness, but they may not qualify for CPAP coverage by Medicare criteria.
