Bias in Scoring Respiratory Events
In a recent article in the Journal of Clinical Sleep Medicine, “The differential impact of respiratory event scoring criteria on CPAP eligibility in women and men,” a bias was demonstrated suggesting limited access to CPAP prescriptions in women, particularly those in the pre, peri- and post-menopausal age range (40 to 60).
The study examined diagnostic sleep study results from 674 women using two different scoring methods. The first, known as the Medicare criteria requires a 4% desaturation to define sleep breathing events. The second, offered by the American Academy of Sleep medicine (AASM) allows for either a 3% oxygen desaturation or an EEG arousal in the brain to define sleep breathing events.
The results compared the expected number of diagnoses based on each criteria, AASM vs Medicare. In every comparison, Medicare sharply decreased the number of positive cases in women. Overall, women were twice as likely to not meet criteria for sleep apnea despite having met the criteria by the AASM. Worse, in the age group from 40 to 60, the women would be 7 times more likely not to be diagnosed with Medicare criteria even though they had met AASM criteria.
These results align with some of the previous posts in that women in the age range of 40 to 60 often suffer from UARS and mild OSA, so this study confirms the Medicare bias against women who undergo sleep testing. The most worrisome aspect of the findings is women often develop hypertension at times near to menopause, which could be linked to their OSA, but Medicare’s biased scoring rules would prevent many of these women from receiving a proper diagnosis and CPAP device.
Last, bear in mind, Medicare rules are often adopted by many other insurers, so on a practical level many women could be affected by this bias.