Sleep Management Guidelines

Covers evaluation and treatment of OSA/sleep‑disordered breathing — specifying indications for home sleep testing (HST) vs in‑lab PSG, PAP therapy (APAP/CPAP/bi‑level/ASV) initiation/continuation/replacement, pediatric in‑lab PSG, oral appliance candidacy, actigraphy and supply frequency limits — and excludes investigational therapies (e.g., Provent, Winx), home/portable testing in children, HST for chronic opioid users, and unsupported DME codes (94799, E1399). Key requirements: a comprehensive clinical evaluation within 60 days with a required sleep questionnaire or proxy, diagnostic thresholds (AHI/RDI ≥15 events/hr or 5–14 with symptoms or relevant comorbidities), face‑to‑face evaluation prior to titration, and documented PAP compliance (≥70% of nights and ≥4 hrs/night for a consecutive 30‑day period within the first 3 months), with specific criteria governing when HST, PSG, repeat testing, or oral appliances are appropriate.

"Positive diagnosis of OSA, as measured by valid testing defined as: The apnea-hypopnea index (AHI) or respiratory disturbance index (RDI) is ≥ 15 events per hour with a minimum of 30 events; or The..."