UnitedHealthcare’s updated medical policy for obstructive and central sleep apnea, effective March 1, establishes oral appliance therapy as a prerequisite therapy for surgical treatment in adult patients with moderate to severe obstructive sleep apnea (OSA). 

Surgical treatments—such as hypoglossal nerve stimulation, uvulopalatopharyngoplasty, mandibular osteotomy, and maxillomandibular osteotomy and advancement—can be used following “failure of adequate trial of oral appliance therapy.” A trial of CPAP therapy also is required. 

“I am pleased to see this policy update acknowledging the role of oral appliances in the continuum of care for obstructive sleep apnea,” says Edward T. Sall, MD, DDS, MBA, who works in private practice in Syracuse, New York, in a release. “Recent research has demonstrated that modern, precision oral appliances are effective and safe. It is good medical practice to exhaust the available, non-invasive, reversible treatment options before moving to surgical options.”

The updated policy states that removable oral appliances are proven and medically necessary for treating OSA, as documented by a sleep study, and that, for many individuals, oral appliance therapy may be an effective alternative to failed CPAP therapy. 

ProSomnus Inc, a maker of oral appliance therapy devices, says in a release that it “welcomes the adoption” of UnitedHealthcare’s updated medical policy.

Data presented at the 2023 World Sleep Congress reported that treatment with ProSomnus’ devices was non-inferior to CPAP. Data published in the medical journal Cureus reported that 89% of patients with OSA of all severities were successfully treated to an AHI of less than 10 with ProSomnus devices. Further, 96% of patients were confirmed to be in active treatment at a one-year follow-up. No patients were excluded due to inadequate dental anatomy.

Photo 72623394 © Jonathan Weiss | Dreamstime.com