The New Local Coverage Determination Criteria for Adherence to Positive Airway Pressure Treatment Testing the Limits?

Background: To our knowledge, the new local coverage determination (LCD) adherence criteria for continued reimbursement of continuous positive airway pressure after 90 days has heretofore not been validated, including the effects of the policy on care for patients with obstructive sleep apnea. Methods: We examined a retrospective database of 150 patients who received neuropsychologic testing prior to treatment and 3 and 6 months post treatment. We categorized participants using the new LCD criteria. Comparisons of neuropsychologic variables were made between adherent and nonadherent groups. Results: Fifty-five participants (37%) failed to meet the new criteria, although this number may not reflect the actual rates of adherence in clinical settings because some efforts beyond standard care were made to ensure adherence to treatment among many of the participants. Of the 50 patients who did not receive any special adherence intervention, only 28 (56%) met the criteria. On most measures, patients with poor adherence demonstrated neuropsychologic improvements similar to their adherent counterparts. Nonadherent patients realized additional improvements in working memory between 3 and 6 months post treatment. Conclusions: This study highlights the potential effects of the new criteria for adherence on patients with obstructive sleep apnea and their clinical care. These data were taken from a study that was not designed to examine these criteria, so controlled trials are needed to better understand the effect of the guidelines on adherence and treatment outcomes.