Placing Sleep Apnea Cases: A Breath Of Fresh Air

Imagine the thought of not being able to take in a breath, then suddenly gasping for air when you’re able to breathe in again. Now, you’re probably thinking to yourself this sounds a lot like the feeling you sometimes get with certain not-so-favorable offers on impaired risk cases!
All kidding aside, this is actually what happens with people who have sleep apnea. An individual suffering from sleep apnea may not even be aware of it while it’s happening, but could still experience symptoms – most commonly, daytime sleepiness, morning headaches and loud snoring. Sleep apnea restricts oxygen to vital organs and if left untreated, it can lead to more serious conditions such as heart arrhythmias, stroke and diabetes.
Diagnosis is usually made after undergoing an overnight sleep study. Severity is measured by the Apnea/Hypopnea Index (AHI) which represents the number of episodes per hour. An AHI score of 5-14 indicates mild severity, 15-30 indicates moderate and over 30 is considered severe.
CPAP (Continuous Positive Airway Pressure) is usually the recommended treatment. Other treatments may include dental appliances or surgery. Follow up sleep studies to monitor the effectiveness of treatment are also often recommended.
So what does all this mean for life underwriting?

The key to favorable outcomes isn’t as much the severity at diagnosis as it is the follow up and compliance to treatment.

In some cases, lack of compliance or failure to follow up can lead to highly rated offers and declines.
Take for instance this case involving severe sleep apnea but with good follow up and compliance:
  • 66 year old male applying for $500k of Term coverage
  • Lifetime non-smoker
  • Height 6’ 4”, weight 220 lbs
  • Hypertension, well controlled on Amlodipine
  • High cholesterol, well controlled on Pravastatin
  • A sleep study done in 2016 revealed severe obstructive sleep apnea with an AHI of 78 and CPAP treatment was initiated
  • Sleep apnea is well controlled, without symptoms, and good compliance on nightly CPAP use.
Underwriting decision: Preferred NS for the sleep apnea history!
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