Obstructive sleep apnea (OSA) is caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses during sleep.
It is possible for applicants who have this condition to get approved for life insurance, depending on severity, treatment and compliance. But advisors who are placing the case need to know what to look for and what to report to the underwriter to achieve the best possible outcome.
First, what are the symptoms? Some people with OSA complain that they wake up with a very sore and/or dry throat. They may on occasion wake up with a choking or gasping sensation and sometimes they seem to wake themselves up with their own loud snoring. In addition, a person with OSA will often report sleepiness during the day due to fragmented sleep.
Other symptoms may include morning headaches, forgetfulness, and mood changes.
Treatment varies. In some cases, it may include loss of weight, surgery for milder forms, masks (devices called continuous positive airway pressure, or CPAPs, to aid breathing) or mouthpieces. CPAP, often called the most successful treatment, is connected to a source of air pressure and is used for moderate to severe sleep apnea.
Physicians usually do not prescribe medication for the treatment of OSA.
Can a person die of this condition? Several studies have concluded that sleep apnea is associated with many stroke and heart attack fatalities.
After talking to several physicians, a sleep technician and a home office underwriter, I found that their opinions were varied with no conclusions as to death as a direct result of OSA. (Note: The only time I have ever heard of anyone dying of the condition was Reggie White of the Green Bay Packers. Initially it was said he died of sleep apnea, but later the cause of death was changed to a massive heart attack.)
OSA can be connected with many types of illness. But, from a life underwritng perspective, the facts are not convincing that the condition is a definite threat to life expectancy on its own, except in the most severe cases. However, accidental death due to sleep deprivation is always a consideration.
When the client has a history of OSA or if it seems possible that OSA may be present, advisors should know that the underwriting will depend on severity, treatment and compliance. The chart illustrates how the ratings might work out.
An important question to ask is, can a person who has the condition lower a rating or become insurable?
Recently, my firm had a case where the applicant had been diagnosed originally with “moderately severe” sleep apnea 4 years ago. After a month of using the CPAP mask, it bothered him so much he decided not use it again. This applicant was declined for being medically non-compliant.
The underwriter stated if the applicant would have a sleep study completed at his expense, the insurance company would reconsider the case.
The mitigating factors were these: Four years ago, at the time of the first sleep study, the applicant, who was five feet 10 inches tall, weighed 245 pounds. But now he weighs 215 pounds, with a weight loss of approximately 10%.
The man did complete a current sleep study, as recommended. The new study showed his sleep apnea was now only in the “mild obstructive” category. He was issued a standard policy.
This example suggests 2 conclusions: First, losing weight is a priority in managing OSA. Second, if a life insurance applicant has been non-compliant from a previous diagnosis, maybe he or she should have a new sleep study completed. Besides, no one really knows how accurate some of these tests are in diagnosing patients.
With smokers, it helps to show the client the non-smoking rates. This can be a financial incentive to quit smoking. Also, if the person is medically non-compliant with OSA, it becomes even more critical, financially speaking, to use the mask or other device prescribed by a physician.
Consider: Assume a person with OSA was going to pay a premium of $1,000 annually for term life insurance. However, this person gets rated at Table 4, or 200% mortality, for being medically non-compliant for OSA. In this case, the premium cost would double to $2,000. That means a 20-year term policy would cost this person $20,000 more over the next 20 years for not being compliant and for not using the mask as directed by the physician.
Are such ratings fair and reflective of true mortality for the problem?
In my opinion, the ratings for mild and moderate obstructive sleep apnea are for snoring and should be eliminated. Also, sleep studies should be done by clinics that do not benefit from the diagnosis or the sale of related equipment.
Reliable numbers do not yet exist on how many people are diagnosed with OSA and how many actually take the sleep tests. But, at agent groups, sleep apnea has become a hot topic.
At each meeting, someone inevitably gets up and gives a testimonial about the benefits of using a CPAP machine–feeling good, sleeping well, and so on. Even those who say nothing has changed admit that, by the using the mask, they stopped snoring–and that has eliminated certain spousal problems.
So OSA is definitely in the air, and insurance people are exploring the nature of the illness, the impact of treatment and compliance, and how to underwrite it.
George Varanakis is chief executive officer of United Producers, Inc. and CPS United Insurance Services, Salt Lake City, Utah. His e-mail address is firstname.lastname@example.org.