Coverage Policy Manual
Policy #: 2007019
Category: Medicine
Initiated: November 2007
Last Review: August 2018
  Multiple Sleep Latency/Maintenance of Wakefulness Test

Description: The American Academy of Sleep Medicine defines excessive sleepiness as sleepiness that occurs in a situation when an individual would be expected to be awake and alert, affecting  approximately 5% of the general population.

The multiple sleep latency test (MSLT) and the Maintenance of Wakefulness test (MWT) are similar tests, in that they both are measures of daytime sleepiness. In the MSLT, the instruction is to try to fall asleep. During the MWT, the patient has multiple trials throughout a day of low-demand activity when the instructions are to resist sleep.

The multiple sleep latency test involves four to six, 20-minute recordings of sleep/wake states and stages, spaced at two hour intervals throughout the day. Therefore, the procedure requires nine to twelve hours to complete. The patient is present at the testing facility and either monitored or observed throughout the day by a trained technologist. The physiological recordings made are similar to those of nighttime polysomnography. Audio and video recordings are also made during the monitored portion of the day.  When these tests are indicated they are typically performed on a day following polysomnography.  

CPT Assistant, February 1998, page 6, provides additional information;
“MSLT or MWT and polysomnography represent separate diagnostic tests that are performed at different times to assess various physiological parameters of sleep; this is one of the key factors that indicate that it is appropriate to report both polysomnography and MSLT or MWT, when both are performed. Typically, polysomnography is performed the night before the MSLT or MWT.”

Policy/
Coverage:
Meets Primary Coverage Criteria Or Is Covered For Contracts Without Primary Coverage Criteria
 
MSLT / MWT meets primary coverage criteria for effectiveness and are covered for the indications below for patients who do not have obstructive sleep apnea or who are compliant with their treatment for obstructive sleep apnea and have continued excessive sleepiness.  
 
MSLT meets primary coverage criteria for effectiveness and is covered to confirm a diagnosis of narcolepsy in patients suspected of having that condition.
 
Repeat MSLT meets primary coverage criteria for effectiveness and is covered when:
    • Ambiguous or interpretable findings are present
    • A patient is suspected of having narcolepsy but a previous MSLT did not provide polygraphic confirmation
 
The MWT meets primary coverage criteria for effectiveness and is covered to monitor response in those patients receiving treatment for excessive sleepiness.

Rationale:
The MSLT and MWT values are influenced by physiological, psychological and test protocol variables.  These tests are most valuable when integrated with the clinical history.  A valid test result can be obtained only if the patient has experienced an adequate quantity and quality of nocturnal sleep  during the night prior to testing with MSLT or MWT.  Many clinicians perform this testing during the day following a polysomnogram the previous night.  The guidelines do not address the value of MLST/MWT when the polysomnogram on the previous night is abnormal.  
 
Bonnet, in 2006, states: “The MSLT must be performed immediately following PSG recorded during the individual’s major sleep period to document no other significant sleep disorder is present to explain the sleepiness complaint (Littner et al., 2005).  At least 6 hours of sleep needs to be recorded in the prior PSG if the results of the MSLT are to be used to confirm a diagnosis of narcolepsy.”  
“Effective clinical use and interpretation of the MSLT and MWT require a better understanding of the sleep need and arousal system effects in normal subjects.  We also need to better understand how age, body weight, activity patterns, motivation, and numerous clinical pathologies impact on the sleep and arousal systems.”
 
2012 Update
A search of the MEDLINE database was conducted through July 2012.  There was no new information identified that would prompt a change in the coverage statement.
 
2014 Update
A literature search conducted through July 2014 did not reveal any new information that would prompt a change in the coverage statement.
  
2015 Update
A literature search conducted through May 2015 did not reveal any new information that would prompt a change in the coverage statement.  
 
2016 Update
A literature search conducted through July 2016 did not reveal any new information that would prompt a change in the coverage statement.
 
2018 Update
Annual policy review completed with a literature search using the MEDLINE database through July 2018. No new literature was identified that would prompt a change in the coverage statement.  

CPT/HCPCS:
95805Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness

References: Arand D, Bonnet M, et al.(2005) Review by the MSLT and MWT Task Force of the Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep, 2005, 28:123-44.

Arand DL.(2006) The MSLT/MWT should be used for the assessment of workplace safety. J Sleep Clin Med, 2006; 2:124-7.

Bonnet MH, Arand DL.(2005) Impact of motivation on Multiple Sleep Latency Test and Maintenance of Wakefulness Test measurements. J Clin Sleep Med, 2005; 1:386-90.

Bonnet MH.(2006) ACNS clinical controversy: MSLT and MWT have limited clinical utility. J Clin Neurophysiol, 2006; 23:50-8.

Bonnet MH.(2006) The MLST and MWT should not be used for the assessment of workplace safety. J Sleep Clin Med, 2006; 2:128-31.

Littner MR, Kushida C, et al.(2005) Standards of Practice Committee of the American Academy of Sleep Medicine. Practice parameters for clinical use of the Multiple Sleep Latency Test and the Maintenance of Wakefulness Test. Sleep, 2005, 28:113-21.

Silber MH.(2006) The investigaion of sleepiness. Sleep Med Clin, 2006; 1:1-17.

Wise MS.(2006) Objective measures of sleepiness and wakefulness: application to the real world. J Clin Neurophysiol, 2006; 23:39-49.


Group specific policy will supersede this policy when applicable. This policy does not apply to the Wal-Mart Associates Group Health Plan participants or to the Tyson Group Health Plan participants.
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