Which guideline does Tricare follow to score sleep studies, Centers for Medicare and Medicaid Services (CMS) or American Academy of Sleep Medicine (AASM)?

TRICARE Follows AASM Guidelines for Scoring Sleep Studies

TRICARE follows the American Academy of Sleep Medicine (AASM) Manual for the Scoring of Sleep and Associated Events as the standard for scoring sleep studies, not the CMS guidelines.

Evidence Supporting AASM Guidelines as the Standard

The AASM has established comprehensive guidelines for sleep study scoring that are widely recognized as the gold standard in sleep medicine. These guidelines provide standardized criteria for:

• Scoring respiratory events (apneas and hypopneas)
• Sleep stage classification
• Arousal identification
• Movement detection

Key Components of AASM Scoring Guidelines

1. Respiratory Event Scoring:

   • The AASM provides specific definitions for apneas and hypopneas
   • Includes recommended sensors and alternative sensors when primary ones fail 1
   • Scoring criteria should be consistent with current published AASM standards 1

2. Sleep Study Interpretation:

   • "Interpretation of sleep studies should be in accordance with the AASM Manual for the Scoring of Sleep and Associated Events" 1
   • Sleep providers should ensure consistency with current accreditation standards 1

3. Quality Assurance:

   • Manual scoring or manual editing of automated scoring by skilled personnel 1
   • Review of raw data by a board-certified sleep specialist 1

Implementation in Clinical Practice

The AASM guidelines are designed to ensure consistency and reliability in sleep study scoring across different facilities. When performing sleep studies under TRICARE:

• Use sensors endorsed in the AASM Manual for scoring respiratory events 1
• Follow AASM-recommended scoring criteria for all sleep parameters 1
• Ensure studies are performed under the auspices of an AASM-accredited comprehensive sleep medicine program 1

Important Considerations

• The AASM scoring manual has undergone several updates since its initial publication in 2007, with significant revisions in 2012 and subsequent years 1
• The AASM has adopted the GRADE (Grading of Recommendation Assessment, Development and Evaluation) methodology for evaluating evidence and forming clinical practice guidelines 1
• Inter-scorer reliability has improved with the implementation of AASM guidelines 2

Common Pitfalls to Avoid

• Using outdated scoring criteria that don't align with current AASM standards
• Relying solely on automated scoring without manual review
• Inconsistent application of scoring rules between different technologists
• Failure to recognize that scoring reliability varies by sleep stage (N1 and N3 stages have lower reliability than other stages) 3

By following the AASM guidelines, TRICARE ensures standardized, evidence-based scoring of sleep studies that facilitates accurate diagnosis and appropriate treatment of sleep disorders.