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Sleep disorders in the pediatric population may be related to snoring, sleep apnea and non-respiratory conditions such as narcolepsy and seizure activity. Although snoring and obstructive sleep apnea are generally the most common indications for evaluation, 25% of pediatric patients referred for evaluation of a sleep disorder may have a suspected non-respiratory condition.
Sleep studies consist of selected diagnostic and therapeutic services provided for sleep-related disorders. Polysomnography is a detailed overnight sleep study that takes place under supervision of a medical professional in a facility-based sleep center. Polysomnography includes recording of electrographic variables (electroencephalogram [EEG], electrooculogram [EOG], and submental electromyogram [EMG]) that permit identification of sleep and its various stages; ventilatory variables that permit the identification of apneas and their classification as central or obstructive; arterial oxygen saturation by ear or finger oximetry; and heart rate. Other parameters of sleep, such as extremity muscle activity, continuous blood pressure monitoring, and body position changes, may be recorded as needed. PSG is distinguished from other sleep studies by the inclusion of EEG, EOG, and EMG for the determination of sleep stage.
Parasomnias are abnormal behavioral, experiential or physiological events that occur during sleep. They may be associated with rapid eye movement (REM) sleep or non-REM (NREM) sleep. Parasomnias can result in serious disruption of sleep-wake schedules and daytime functioning. Some, particularly sleep walking and sleep terrors, can cause injury to the patient and others.
Multiple sleep latency testing (MSLT) consists of physiological measurements of sleep during a series of 20 minute naps at two-hour intervals performed four to five times in an eight-hour period. The maintenance of wakefulness test (MWT) measures the ability to stay awake in a sleep inducing environment. Although MWT is generally used to assess occupational safety in adults, it has been proposed for sleep disorder testing in children and adolescents.
Note: This policy applies to children and adolescents up to age 18.
For applicable clinical criteria, see the following eviCore clinical guideline(s):
No additional statements.
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Note that services with specific coverage criteria may be reviewed retrospectively to determine if criteria are being met. Retrospective denial of claims may result if criteria are not met.
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Acknowledgements:
CPT® codes copyright American Medical Association® 2023. All rights reserved.
CDT codes copyright American Dental Association® 2023. All rights reserved.
