Clinical UM Guideline

This document addresses selected services for the diagnosis of sleep disorders including:

• “Nap” studies
• Actigraphy, including use of static charge sensitive beds
• Diagnostic audio recording, with or without pulse oximetry to document sleep apnea
• Topographic brain mapping
• Acoustic pharyngometry

Note: For criteria related to other sleep testing services, refer to applicable guidelines used by the plan.

Note: For a high-level overview of this document, please see 'Summary for Members and Families' below.

Not Medically Necessary:

“Nap” studies are considered not medically necessary either for screening purposes or as an alternative to polysomnography for the diagnosis of obstructive sleep apnea or narcolepsy.

The following diagnostic tests are considered not medically necessary:

1. Diagnostic audio recording, with or without pulse oximetry, to document sleep apnea;
2. Topographic brain mapping;
3. Acoustic pharyngometry (Eccovision^™ Acoustic Pharyngometer^®);
4. Actigraphy or static charge sensitive beds.

This document describes clinical studies and expert recommendations and explains whether certain medical services are appropriate. The following summary does not replace the medical necessity criteria or other information in this document. The summary may not contain all of the relevant criteria or information. This summary is not medical advice. Please check with your healthcare provider for any advice about your health.

Key Information

This document addresses certain portable tests sometimes used to diagnose sleep disorders. This includes a collection of methods including nap studies, actigraphy (a method that tracks body movement), audio recordings  topographic brain mapping (a test that creates a map of the brain’s surface by recording electrical activity during sleep), and acoustic pharyngometry (a test that uses sound waves to measure the upper airway, from the lips to the top of the lungs). These tests are sometimes proposed as simpler or more convenient tests compared to full in-lab sleep studies. However, studies show that these options do not give enough accurate or complete information to help make treatment decisions. Experts recommend full overnight sleep studies (called polysomnography) or full home sleep studies as the best ways to diagnose sleep problems.

What the Studies Show

Nap studies track sleep during short daytime periods. But nap sleep is different from night sleep and does not show the full range of sleep stages. As a result, nap studies do not provide enough information to diagnose conditions like sleep apnea or narcolepsy. Actigraphy can measure movement patterns during sleep and has shown some use in tracking sleep timing and circadian rhythm problems. However, it is not accurate enough to identify specific sleep disorders. Audio recordings and oximetry (measurement of the oxygen content of the blood) may detect breathing pauses, but miss other important signals, making misdiagnosis more likely. Acoustic pharyngometry may show where airways are narrow and limit air flow, but the data collected during that type of test has not been shown to change treatment decisions. Topographic brain mapping has not been well studied, and the research to date is very limited and does not show that it helps doctors make better decisions.

Is this clinically appropriate?

These tests are not appropriate because they have not been proven to improve health. Studies show that nap studies, actigraphy, diagnostic audio recordings (with or without oximetry), topographic brain mapping, and acoustic pharyngometry do not provide reliable or complete information, or change doctor’s treatment decisions in their absence. Better studies are needed to know if these methods are helpful in diagnosing sleep disorders. Using tests that are not accurate can lead to missed or wrong diagnoses, unneeded treatments, and extra worry for individuals.

(Return to Description)

The following codes for treatments and procedures applicable to this guideline are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

When services are Not Medically Necessary:

Summary

This document addresses selected services proposed for the diagnosis of sleep disorders, including nap studies, actigraphy, diagnostic audio recordings (with or without pulse oximetry), topographic brain mapping, and acoustic pharyngometry. The evidence base does not support these tests as valid alternatives to full polysomnography, as they provide incomplete or inconsistent diagnostic information. For example, nap studies fail to replicate normal sleep architecture, actigraphy lacks demonstrated benefit for sleep disorder evaluation, and audio recording with oximetry omits critical physiologic data. Similarly, acoustic pharyngometry and topographic brain mapping have limited evidence and unclear impact on clinical decision-making. Professional guidance cited includes multiple clinical practice parameters and guidelines from the American Academy of Sleep Medicine (AASM), American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and U.S. Department of Veterans Affairs/Department of Defense, which consistently endorse polysomnography or validated portable monitoring methods as the diagnostic standards for sleep disorders.

Discussion

Sleep disorders are common and impact quality of life (QOL), productivity, and overall health. There are many different types of sleep-related disorders, including obstructive sleep apnea (OSA), upper airway resistance syndrome (UARS), insomnia, narcolepsy, nocturnal movement disorders, such as restless leg syndrome (RLS) and Periodic Limb Movement Disorder, unexplained excessive daytime sleepiness, and arousal disorders (parasomnias).

Sleep disorder studies are used to determine or confirm a diagnosis related to sleep disturbances. These tests vary in the number and nature of sleep parameters that are measured, to gain an understanding of the conditions under which sleep disturbances occur.

Many portable tests have been proposed as alternatives to laboratory-based PSG for the diagnosis and follow-up of sleep disorders. These tests include, but are not limited, to: “nap studies,” actigraphy, diagnostic audiotaping, topographic brain mapping, and acoustic pharyngometry. However, none of these portable tests currently provide diagnostic information comparable to established Type III home portable monitors (HPM), which monitor and record a minimum of four parameters: respiratory movement/effort, airflow, ECG/heart rate, and oxygen saturation.

Nap studies are diagnostic tests that track and record multiple body symptoms generally used to detect various sleep disorders. The evidence in the medical literature does not support the use of single nap studies. Nap studies are not considered equivalent to sleep studies conducted in a formal sleep laboratory. Wide deviations in the conditions and data collection methods available cause significant variability in the outcomes of these studies and do not allow for proper sleep assessment. Additionally, nap sleep is not physiologically the same as nighttime sleep and does not adequately reflect the range of sleep phases required for proper diagnosis, therefore, results are not accurate when compared to the current standard of a full polysomnography (PSG) (Kapur, 2017).

In 2025, van Doorn and colleagues published a Cochrane systematic review evaluating the clinical utility of limited channel sleep studies (Level II-IV) compared to in-laboratory PSG for the diagnosis of obstructive sleep apnea. The analysis included three randomized controlled trials (n=1143) and found no significant differences between Level II or Level III studies and PSG for key outcomes such as daytime sleepiness, quality of life, or adherence to continuous positive airway pressure therapy over 6-12 months of follow-up. Evidence quality was rated as high for Level II versus PSG comparisons and moderate for Level III versus PSG, but authors emphasized that data remain limited, particularly for Level IV testing. The review concluded that while some limited channel studies may provide comparable outcomes to PSG in selected populations, uncertainty remains regarding their broader applicability and long-term impact on clinical decision-making.

While the use of actigraphy has been demonstrated to be useful in the detection of sleep, potential benefits for individuals with suspected sleep disorders have not been shown (Conley, 2019). In 2025, Maia and colleagues published a systematic review and meta-analysis evaluating actigraphy in central disorders of hypersomnolence, including narcolepsy type 1, idiopathic hypersomnia, Kleine-Levin syndrome, and other neurologic or psychiatric conditions. Across eight studies (n=473), actigraphy demonstrated differences in total sleep time, sleep efficiency, wake after sleep onset, and nap duration compared with control participants, supporting its potential value for objectively characterizing sleep patterns in hypersomnolence. However, the authors emphasized the lack of standardized protocols and guidelines, limiting the ability to generalize findings or recommend actigraphy as a diagnostic tool in routine clinical practice. Similarly, static charge sensitive beds, another movement-based surrogate of sleep, lack evidence for diagnostic accuracy or management impact compared with PSG. The current body of evidence supporting the use of actigraphy for individuals with sleep disorders is insufficient to allow adequate conclusions regarding efficacy (Maia, 2025; Marino, 2013; Smith, 2018).

Circadian rhythm disorders are disruptions in an individual’s circadian rhythm, which is set by the cycle of light and dark over 24 hours and regulates sleep-wake patterns. Actigraphy can be used to measure circadian rhythm cycles in individuals with suspected circadian rhythm sleep-wake disorders. It collects data on sleep and activity patterns, producing graphs that provide estimates comparable to those obtained by PSG (Smith, 2018).

The potential benefits of diagnostic audio recording, used alone or in conjunction with pulse oximetry, have not been demonstrated to provide clinical benefits equivalent to PSG. While such methods do potentially identify occurrences of sleep apnea, other aspects of physiological functioning are not recorded simultaneously, thus providing an incomplete clinical picture and allowing the possibility of misdiagnosis (Kapur, 2017).

The Eccovision Acoustic Pharyngometer (Hood Laboratories; Pembroke, MA) is a noninvasive testing device intended to measure the upper respiratory airway by means of acoustic reflection. Some studies have suggested a correlation between pharyngeal cross-sectional areas measured using acoustic pharyngometry and the presence of OSA. In addition, studies have suggested that acoustic pharyngometry may be useful in identifying sites of airway narrowing. However, the utility of acoustic pharyngometry measurement in the clinical setting of OSA has not been demonstrated, and it remains unclear how this test will impact treatment planning and clinical outcomes (Kamal, 2004).

Topographic brain mapping has been briefly described in the evaluation and diagnosis of OSA. However, the evidence is limited to small case series studies that do not allow adequate evaluation of this technology. At this time, the level of evidence supporting topographic brain mapping is insufficient to make any recommendations (Lucey, 2016).

Acoustic Pharyngometer (Eccovision): This is a device that analyzes sound waves that travel along a wave tube into an individual’s airways. The output of the wave signals results in a graphical display of the relationship between the cross-sectional area and distance down the airway. This allows individuals to measure pharyngeal airway size and stability.

Actigraphy: This is a method used to study sleep-wake patterns and circadian rhythms by assessing the subject’s movement over a period of time. Measurements usually involve the detection of wrist movements.

Airflow and respiratory effort in conjunction with oxygen saturation: These terms are translated into the standard measures of apneic-hypopnea index (AHI) or respiratory disturbance index (RDI). Oxygen saturation measures the significance of respiratory events.

Apnea: A transient period where breathing ceases.

Apnea-Hypopnea index (AHI) or Respiratory disturbance index (RDI): A measure of apnea severity defined by the total number of episodes of apnea or hypopnea during a full period of sleep divided by the number of hours asleep.

Epworth sleepiness scale (ESS): A standardized measure of the degree of sleepiness.

Excessive daytime sleepiness: This refers to a condition where a person feels very drowsy during the day, even after getting adequate nighttime rest, and has a tendency to fall asleep or requires extra effort to avoid sleeping in inappropriate situations, such as at work or driving. This condition is also defined as a score greater than or equal to 10 on the Epworth Sleepiness Scale.

Hypopnea: Breathing that is shallower, and/or slower, than normal.

Nap study: This refers to a shorter daytime version of a PSG sleep study.

Narcolepsy: This refers to a neurological condition, where individuals experience profound daytime sleepiness, which may also include sudden, periodic, and transient loss of muscle tone associated with extreme emotions, such as laughter or anger (cataplexy).

Obstructive sleep apnea (OSA): This is a form of sleep disturbance, which occurs as the result of a physical occlusion of the upper airway during sleep, which interferes with normal breathing. The occlusion is usually in the back of the tongue and/or flabby tissue in the upper airway. This condition is associated with frequent awakening and often with daytime sleepiness.

Sleep disorder: A disruptive pattern of sleep that may include difficulty falling or staying asleep, falling asleep at inappropriate times, excessive total sleep time, or abnormal behaviors associated with sleep.

Upper airway: The area of the upper respiratory system including the nose, mouth and throat.

Peer Reviewed Publications:

1. Conley S, Knies A, Batten J, et al. Agreement between actigraphic and polysomnographic measures of sleep in adults with and without chronic conditions: a systematic review and meta-analysis. Sleep Med Rev. 2019; 46:151-160.
2. D'Andrea LA. Diagnostic studies in the assessment of pediatric sleep-disordered breathing: techniques and indications. Pediatr Clin North Am. 2004; 51(1):169-186.
3. Flemons WW. Clinical practice. Obstructive sleep apnea. N Engl J Med. 2002; 347(7):498-504.
4. Guilleminault C, Abad VC. Obstructive sleep apnea syndromes. Med Clin North Am. 2004; 8(3):611-630.
5. Hyde M, O'Driscoll DM, Binette S, et al. Validation of actigraphy for determining sleep and wake in children with sleep disordered breathing. J Sleep Res. 2007; 16(2):213-216.
6. Kamal I. Acoustic pharyngometry patterns of snoring and obstructive sleep apnea patients. Otolaryngol Head Neck Surg. 2004; 130(1):58-66.
7. Lucey BP, Mcleland JS, Toedebusch CD, et al. Comparison of a single-channel EEG sleep study to polysomnography. J Sleep Res. 2016; 25(6):625-635.
8. Levenson JC, Troxel WM, Begley A, et al. A quantitative approach to distinguishing older adults with insomnia from good sleeper controls. J Clin Sleep Med. 2013; 9(2):125-131.
9. Maia S, Soares JI, Borges DF, et al. The role of actigraphy in the assessment of central disorders of hypersomnolence: a systematic review and meta-analysis. Can J Neurol Sci. 2025:1-9.
10. Marino M, Li Y, Rueschman MN, et al. Measuring sleep: accuracy, sensitivity, and specificity of wrist actigraphy compared to polysomnography. Sleep. 2013; 36(11):1747-1755.
11. Monahan KJ, Larkin EK, Rosen CL, et al. Utility of noninvasive pharyngometry in epidemiologic studies of childhood sleep-disordered breathing. Am J Respir Crit Care Med. 2002; 165(11):1499-1503.
12. Mulgrew AT, Fox N, Ayas NT, Ryan CF. Diagnosis and initial management of obstructive sleep apnea without polysomnography: a randomized validation study. Ann Intern Med. 2007; 146(3):157-166.
13. O'Driscoll DM, Foster AM, Davey MJ, et al. Can actigraphy measure sleep fragmentation in children? Arch Dis Child. 2010; 95(12):1031-1033.
14. Strollo PJ Jr. Indications for treatment of obstructive sleep apnea in adults. Clin Chest Med. 2003, 24(2):307-313.
15. Werner H, Molinari L, Guyer C, Jenni OG. Agreement rates between actigraphy, diary, and questionnaire for children's sleep patterns. Arch Pediatr Adolesc Med. 2008; 162(4):350-358.
16. Westbrook PR, Levendowski DJ, Cvetinovic M, et al. Description and validation of the apnea risk evaluation system: a novel method to diagnose sleep apnea-hypopnea in the home. Chest. 2005; 128(4):2166-2175.
17. Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA. 2004; 291(16):2013-2016.
18. Yavuz-Kodat E, Reynaud E, Geoffray MM, et al. Validity of actigraphy compared to polysomnography for sleep assessment in children with autism spectrum disorder. Front Psychiatry. 2019; 10:551.

Government Agency, Medical Society, and Other Authoritative Publications:

1. American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Version 3.0. Darien, IL: AASM; February, 2023. Available at: https://aasm.org/wp-content/uploads/2023/05/Summary-of-Updates-Scoring-Manual-v3.pdf. Accessed on October 16, 2025.
2. Centers for Medicare and Medicaid Services. National Coverage Determination for Sleep Testing for Obstructive Sleep Apnea. NCD #240.4.1. Effective March 3, 2009. Available at: https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=330&ncdver=1&DocID=240.4.1&ncd_id=240.4&ncd_version=3&basket=ncd%25253A240%25252E4%25253A3%25253AContinuous+Positive+Airway+Pressure+%252528CPAP%252529+Therapy+For+Obstructive+Sleep+Apnea+%252528OSA%252529&bc=gAAAAAgAAAAA&. Accessed on October 16, 2025.
3. Collop NA, Anderson WM, Boehlecke B, et al. Portable Monitoring Task Force of the American Academy of Sleep Medicine. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. J Clin Sleep Med. 2007; 3(7):737-747.
4. Collop NA, Tracy SL, Kapur V, et al. American Academy of Sleep Medicine (AASM). Obstructive Sleep apnea Devices for Out-Of-Center (OOC) testing: Technology Evaluation. J Clin Sleep Med. 2011; 7(5):531-548.
5. Flemons WW, Littner MR, Rowley JA, et al. Home diagnosis of sleep apnea: a systematic review of the literature. An evidence review cosponsored by the American Academy of Sleep Medicine, the American College of Chest Physicians, and the American Thoracic Society. Chest. 2003; 124(4):1543-1579.
6. Iber C, Ancoli-Israel S, Chesson AL, Quan SF. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Westchester, IL: American Academy of Sleep Medicine; 2007.
7. Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017; 13(3):479-504.
8. Kirk V, Baughn J, D'Andrea L, et al. American Academy of Sleep Medicine Position Paper for the Use of a Home Sleep Apnea Test for the Diagnosis of OSA in Children. J Clin Sleep Med. 2017; 13(10):1199-1203.
9. Littner M, Hirshkowitz M, Kramer M, et al. American Academy of Sleep Medicine; Standards of Practice Committee. Practice parameters for using polysomnography to evaluate insomnia: an update. Sleep. 2003; 26(6):754-760.
10. Marcus CL, Brooks LJ, Draper KA, et al. American Academy of Pediatrics (AAP). Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012; 130(3):576-584.
11. Mysliwiec V, Martin JL, Ulmer CS, et al. The management of chronic insomnia disorder and obstructive sleep apnea: synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines. Annals Intern Med. 2020; 172(5):325-336.
12. Smith MM, McCrae CC, Cheung JJ, et al. Use of actigraphy for the evaluation of sleep disorders and circadian rhythm sleep-wake disorders: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med, 2018; 14(7):1231-1237.
13. Thurnheer R, Bloch KE, Laube I, et al.; Swiss Respiratory Polygraphy Registry. Respiratory polygraphy in sleep apnea diagnosis. Report of the Swiss respiratory polygraphy registry and systematic review of the literature. Swiss Med Wkly. 2007; 137(5-6):97-102.
14. Trikalinos TA, Ip S, Raman G, et al. Home diagnosis of obstructive sleep apnea-hypopnea syndrome. AHRQ Technology Assessment Program. Agency for Healthcare Research and Quality (AHRQ), Rockville, MD; August 8, 2007.
15. van Doorn S, Idema DL, Heus P, et al. Clinical utility of limited channel sleep studies versus polysomnography for obstructive sleep apnoea. Cochrane Database Syst Rev. 2025; 5(5):CD013810.

1. American Academy of Sleep Medicine. Sleep education. Sleep Disorders. Available at: https://sleepeducation.org/. Accessed on September 8, 2025.

Actigraphy
Acoustic Pharyngometry
Apnea/Hypopnea Index (AHI)
Apnea Risk Evaluation System (ARES^™)
Nap Study
Obstructive Sleep Apnea (OSA)
Quantitative EEG Mapping
SleepStrip^® II (S.L.P. Ltd.; Israel)
SNAP Testing System (Snap Diagnostics, LLC; Vernon Hills, IL)
Static Charge Sensitive Beds
Topographic EEG Mapping

The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

Federal and State law, as well as contract language including definitions and specific coverage provisions/exclusions, and Medical Policy take precedence over Clinical UM Guidelines and must be considered first in determining eligibility for coverage. The member's contract benefits in effect on the date that services are rendered must be used. Clinical UM Guidelines, which address medical efficacy, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving, and we reserve the right to review and update Clinical UM Guidelines periodically. Clinical UM guidelines are used when the plan performs utilization review for the subject. Due to variances in utilization patterns, each plan may choose whether or not to adopt a particular Clinical UM Guideline. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the back of the member's card.