Korean J Otorhinolaryngol-Head Neck Surg.  2023 Feb;66(2):99-105. 10.3342/kjorl-hns.2022.00122.

Changes in Patients Who Receive Coverage for Positive Airway Pressure Therapy According to Alterations in National Health Insurance Benefit Standards for Mild Obstructive Sleep Apnea

• Yoo J
• Kim JH
• Park DH
• Lim SJ
• Seo MY
• Lee SH

• KMID: 2540001
• DOI: http://doi.org/10.3342/kjorl-hns.2022.00122

Abstract

Background and Objectives
The aim of this study was to identify the frequency of indicators of National Health Insurance (NHI) coverage for positive airway pressure (PAP) therapy and to investigate the changes in patients receiving coverage for PAP therapy after the alterations were made in the insurance benefit standards for mild obstructive sleep apnea (OSA).
Subjects and Method
We divided the mild OSA patients into two groups according to altered categorization in insurance benefit standards (Mild1: 5≤AHI<10; Mild2: 10≤AHI<15). Eight indicators related to the NHI coverage were identified: four symptoms, three complications, and the minimal blood oxygen saturation during polysomnography (min SpO2) of ≤85% during polysomnography. We also investigated the change in the number of patients receiving insurance benefits under the altered insurance benefit standards.
Results
Of the 233 OSA patients, 66, 57, and 110 patients were diagnosed as mild, moderate and severe OSA, respectively. For all of them, the most common indicator related to NHI coverage for PAP therapy was the minimum SpO2 of less than 85% during polysomnography, and the second most common indicator was daytime sleepiness. In the mild OSA group, however, daytime sleepiness was found to be the most common indicator, found in 46 (70%) patients, followed by 38 (58%) patients with min SpO2 of less than 85%. In this group, 59 (89.4%) would have been benefited before the change in the insurance benefit standards whereas 51 patients (77.3%) would now be benefited under the changed insurance benefit standards.
Conclusion
Daytime sleepiness was the most commonly observed indicator in the mild OSA patients. The number of patients receiving insurance benefits for PAP therapy significantly decreased after the change was made in the NHI benefit standards for mild OSA

Keyword

Continuous positive airway pressure; National Health Programs; Obstructive sleep apnea