Sleep Apnea: Assessment of Adherence to Obstructive Sleep Apnea (OSA) Therapy
Percentage of patients aged 18 years and older with a diagnosis of obstructive sleep apnea (OSA) that were prescribed an evidence-based therapy that had documentation that adherence to therapy was assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available).
Last updated: January 15, 2026
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Estimate only — actual CMS scoring may vary based on reporting method, data completeness, and annual rule updates.
📖Clinical Rationale
This recommendation is based on evidence that therapy adherence is extremely important for patients with OSA to experience improvement in signs and symptoms of OSA. Although positive airway pressure (PAP) has been the most efficacious therapy and is often the first option for OSA patients. For patients with mild or moderate OSA, oral appliances may also be appropriate therapy.
However, some patients find such devices to be intrusive, inconvenient, or intolerable. Surgical modification of the upper airway is also a viable treatment for selected patients. Under ideal circumstances, patients with inadequate PAP utilization will have had an opportunity to consult with a sleep medicine professional to address barriers to adherence, although access to such resources may be limited in some areas.
A threshold for adequate PAP adherence will vary between patients depending on their individual underlying medical history, symptomatology, disease severity, and response to PAP, and should be part of the discussion between the health care provider and patient. OSA is a chronic disease that rarely resolves except with substantial weight loss or successful corrective surgery.
As with other chronic diseases, periodic follow-up by a qualified clinician (eg, physician or advanced practice provider) is necessary to confirm adequate treatment, assess symptom resolution, and promote continued adherence to treatment. Initial treatment of OSA requires close monitoring and early identification of difficulties with PAP use, as adherence over the first few days to weeks has been shown to predict long-term adherence.
Objective monitoring of PAP therapy should be performed to complement patient reporting of difficulties with PAP use, as patients often overestimate their use of PAP treatment. PAP therapy remains the gold standard for treating OSA. Alternative approaches may be appropriate for patients unable to tolerate PAP. Untreated OSA can cause daytime sleepiness, reduced productivity, increased accident risk, and worsening cardiovascular conditions such as hypertension, atrial fibrillation, and stroke.
📝Clinical Recommendations
The AASM Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure clinical practice guideline recommends that clinicians use positive airway pressure, compared to no therapy, to treat OSA in adults with excessive sleepiness (Patil, 2019). The AASM Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy clinical practice guideline update recommends that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without obstructive sleep apnea) (Ramar, 2015).
The AASM Referral of Adults with Obstructive Sleep Apnea for Surgical Consultation clinical practice guideline recommends that clinicians discuss referral to a sleep surgeon with adults with OSA and BMI < 40 kg/m2 who are intolerant or unaccepting of PAP as part of a patient-oriented discussion of alternative treatment options (Kent, 2021). The AASM Referral of Adults with Obstructive Sleep Apnea for Surgical Consultation clinical practice guideline recommends that clinicians discuss referral to a bariatric surgeon with adults with OSA and obesity (class II/III, BMI ≥ 35) who are intolerant or unaccepting of PAP as part of a patient-oriented discussion of alternative treatment options (Kent, 2021).
The AASM Referral of Adults with Obstructive Sleep Apnea for Surgical Consultation clinical practice guideline suggests that clinicians discuss referral to a sleep surgeon with adults with OSA, BMI < 40 kg/m2, and persistent inadequate PAP adherence due to pressure-related side effects as part of a patient-oriented discussion of adjunctive or alternative treatment options (Kent, 2021).
The AASM Referral of Adults with Obstructive Sleep Apnea for Surgical Consultation clinical practice guideline suggests that clinicians recommend PAP as initial therapy for adults with OSA and a major upper airway anatomic abnormality prior to consideration of referral for upper airway surgery (Kent, 2021). Adequate follow-up, including troubleshooting and monitoring of objective efficacy and usage data to ensure adequate treatment and adherence, should occur following PAP therapy initiation and during treatment of OSA (Patil et al, 2019).
📋Implementation Notes
This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this patient-process measure is submitted a minimum of once per patient during the performance period. The most advantageous quality data code will be used if the measure is submitted more than once.
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