Clinical UM Guideline

This document addresses the use of apnea (cardiorespiratory) monitors for use in the home to monitor both respiratory and heart rates in infants. An alarm will sound if there is respiratory cessation (apnea) beyond a predetermined time limit (for example, 20 seconds), or if the heart rate falls below a preset rate (bradycardia).

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

Medically Necessary:

Home cardiorespiratory (that is, apnea) monitoring is considered medically necessary in any of the following infants:

1. Those who have experienced a brief resolved unexplained event (BRUE). If monitored due to BRUE, use of an apnea monitor is considered medically necessary until event free for 2 to 3 months.
2. Those with tracheostomies or anatomic abnormalities of the face, tongue, jaw or airway that make them vulnerable to airway compromise.*
3. Those with neurologic or metabolic disorders affecting respiratory control.*
4. Those with chronic lung disease (such as, bronchopulmonary dysplasia), particularly those requiring supplemental oxygen; continuous positive airway pressure; or mechanical ventilation.*
5. Those with apnea of prematurity, defined as sudden cessation of breathing that lasts for at least 20 seconds or is accompanied by bradycardia (heart rate less than 80 beats per minute) or oxygen (O₂) desaturation (O₂ saturation less than 90% or cyanosis) in an infant with early home discharge prior to term (38 weeks). Continued use is considered medically necessary up to 43 weeks postmenstrual age or event free for 2 weeks, whichever comes later.
6. Those discharged home on a schedule of weaning narcotics.*
7. Those with bradycardia on caffeine, theophylline, or similar agents, until event free for 2 weeks off medication.
8. Those with diagnosis of pertussis, with positive cultures. If monitored for pertussis, use of a monitor is considered medically necessary for up to one month post diagnosis.
9. Those with diagnosis of gastroesophageal reflux disease (GERD) that results in apnea (at least 20 seconds), bradycardia (heart rate less than 80 beats per minute), or oxygen desaturation (O₂ saturation less than 90% or cyanosis), until event free for 6 weeks.

*Note: See Duration section below.

Other considerations:

1. The home monitor should be equipped with an event recorder.
2. The physician should establish a specific plan for periodic review and termination of the home monitor before initiating therapy.

Note: Short-term monitoring to assist the family transition to home may be indicated in some cases following a previous sibling death from sudden infant death syndrome (SIDS) or following a particularly complex and protracted neonatal hospital course.

Not Medically Necessary:

Home apnea monitoring is considered not medically necessary for infants who do not meet the medically necessary criteria listed above.

Duration:

• Infant apnea monitors are usually considered medically necessary for approximately 3 months except for specific conditions listed above.
• Continued use of an apnea monitor is considered medically necessary, even when infants become 12 months old during the course of a specified medically necessary duration of use.
• Apnea monitoring beyond 12 months old requires physician documentation supporting the continuation of monitoring.

This document describes clinical studies and expert recommendations, and explains when home infant apnea monitors are clinically 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

Home apnea monitors, also called cardiorespiratory monitors, track an infant’s breathing and heart rate at home. An alarm sounds if breathing stops for a set time or if the heart rate drops too low. These devices are used for certain infants at higher risk of breathing or heart problems. They are not used to prevent sudden infant death syndrome (SIDS) because studies have not shown that they reduce this risk. Monitors can help detect problems early, but they can also lead to false alarms and may make caregivers rely less on safe sleep practices. Careful planning is needed to decide when to start and stop monitoring.

What the Studies Show

Home apnea monitors record breathing patterns and heart rate, and some include event recorders so health care providers can review what happened during an alarm. They can help tell the difference between types of apnea, which means pauses in breathing. These include central apnea, where breathing stops, obstructive apnea, where airflow is blocked, and mixed apnea. This information can guide care. The monitors are most useful in infants with known medical problems that affect breathing or airway safety.

Research and expert guidance from the American Academy of Pediatrics (AAP) show that these monitors do not reduce the risk of SIDS. Because of this, they cannot be used just to prevent SIDS. Studies also raise concerns that caregivers may feel overly reassured by the monitor and may not follow safe sleep practices as closely. Monitors can also cause frequent alarms that are not true emergencies, which may lead to unnecessary worry or extra medical visits.

When is Home Apnea Monitoring Clinically Appropriate?

Home apnea monitoring may be appropriate in these situations:

• Infants who had a brief resolved unexplained event, also called BRUE, until they have no events for 2 to 3 months; or
• Infants with tracheostomies or physical differences of the face, jaw, tongue, or airway that raise risk of blockage; or
• Infants with brain or metabolic conditions that affect breathing control; or
• Infants with chronic lung disease, especially those needing oxygen, breathing support, or a ventilator; or
• Infants born early with apnea of prematurity, until about 43 weeks postmenstrual age or until event free for 2 weeks, whichever is later; or
• Infants going home while reducing narcotic medicines; or
• Infants with low heart rate while on medicines like caffeine (Cafcit) or theophylline (Theo-24), until event free for 2 weeks after stopping medicine; or
• Infants with whooping cough, also called pertussis, for up to 1 month after diagnosis; or
• Infants with gastroesophageal reflux disease, also called GERD, that causes apnea, low heart rate, or low oxygen levels, until event free for 6 weeks.

Monitoring is usually used for about 3 months, but longer use may be needed in some cases. A doctor should review use often and plan when to stop.

When is this not Clinically Appropriate?

Home apnea monitoring is not clinically appropriate for infants who do not meet the conditions listed above. Studies show these monitors do not prevent SIDS and do not improve outcomes in lower risk infants. Unnecessary monitoring can lead to needless worry. It may also reduce attention to safe sleep practices, which are important for infant safety.

(Return to Description)

The following codes for treatments and procedures applicable to this document 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 may be Medically Necessary when criteria are met:

When services are Not Medically Necessary:
For the procedure codes listed above when criteria are not met.

When services are also Not Medically Necessary:

Summary

Home apnea cardiorespiratory monitors are FDA class II devices designed to detect cessation of breathing and/or bradycardia in infants by tracking respiratory patterns and related physiologic parameters, triggering alarms to prompt caregiver intervention. These devices often incorporate event recorders for clinical review. Although originally intended to reduce infant mortality by identifying central apnea or bradycardia, current evidence and American Academy of Pediatrics (AAP) guidance do not support their use as a strategy to prevent SIDS, and routine monitoring has not been shown to reduce SIDS incidence. Instead, their use is limited to select high-risk populations, such as infants with significant respiratory control disorders, chronic lung disease, airway abnormalities, or certain neurologic or metabolic conditions. The AAP further recommends against initiating home monitoring in infants classified as lower risk following a brief resolved unexplained event (BRUE), emphasizing careful risk stratification to avoid unnecessary interventions. Clinicians should also be aware of potential unintended consequences, such as caregiver complacency with safe sleep practices. When prescribed, monitors with event recording capabilities can aid in differentiating central, obstructive, and mixed apnea, thereby informing targeted management strategies.

Discussion

Infant home apnea monitors were designed with the purpose of protecting infants by identifying central apnea or bradycardia and signaling for parental intervention to prevent death (Halbower, 2008). Data recording devices are used with the monitor so the health care provider can analyze events that may occur during the monitoring period. The U.S. Food and Drug Administration (FDA, 2002) 510K premarket review process for class II devices defines apnea monitors as:

A complete system intended to alarm primarily upon the cessation of breathing timed from the last detected breath. The apnea monitor also includes indirect methods of apnea detection, such as monitoring of heart rate and other physiological parameters linked to the presence or absence of adequate respiration.

The AAP task force on sudden infant death syndrome (2005) recommendations regarding SIDS and home sleeping environments identified infants who could benefit from home monitoring, not because of an increased risk of SIDS, but because of other factors that increase the risk of sudden death. These infants include those that have:

• experienced an apparent life threatening event [ALTE (renamed and redefined as brief resolved unexplained event (BRUE) in the AAP 2016 clinical practice guideline)]
• tracheostomies or anatomic abnormalities that make them vulnerable to airway compromise
• neurologic or metabolic disorders affecting respiratory control
• chronic lung disease (for example, bronchopulmonary dysplasia), particularly those requiring supplemental oxygen; continuous positive airway pressure; or mechanical ventilation.

In the 2022 update of recommendations for apnea monitors as a strategy to reduce SIDS, the AAP policy notes,

Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS. The use of cardiorespiratory monitors has not been documented to decrease the incidence of SIDS. These devices are sometimes prescribed for use at home to detect apnea or bradycardia and, when pulse oximetry is used, decreases in oxyhemoglobin saturation for infants at risk of these conditions, including some preterm infants with an unusually prolonged course of recurrent, extreme apnea. In addition, routine in-hospital cardiorespiratory monitoring before discharge from the hospital has not been shown to detect infants at risk of SIDS. There are no data that other commercial devices that are designed to monitor infant vital signs reduce the risk of SIDS.

The 2022 AAP policy further notes that there is a concern that use of home cardiorespiratory monitors may cause a sense of complacency and decreased adherence to AAP safe sleep guidelines in parents and caregivers.

The AAP clinical practice guideline (Tieder, 2016) addresses the evaluation of lower-risk infants who have experienced apparent life-threatening events (ALTEs). The AAP Subcommittee on Apparent Life Threatening Events committee recommends replacing the term ALTE with BRUE. AAP defines BRUE as:

An event occurring in an infant < 1 year of age when the observer reports a sudden, brief*, and now resolved episode of ≥ 1 of the following:

• cyanosis or pallor
• absent, decreased, or irregular breathing
• marked change in tone (hyper or hypotonia)
• altered level of responsiveness

Moreover, clinicians should diagnose a BRUE only when there is no explanation for a qualifying event after conducting an appropriate history and physical examination

* By consensus, the subcommittee established < 1 minute as the upper limit of a "brief event," understanding that objective, verifiable measurements were rarely, if ever, available.

The authors note that the use of BRUE, which uses more objective, specific defining criteria, and excludes symptomatic infants (such as those with fever or respiratory events), allows for a more precise diagnosis to “prevent the overuse of medical interventions by helping clinicians distinguish infants with lower risk”. In order to be designated as lower risk, the following criteria need to be met:

• Age > 60 days
• Prematurity: gestational age ≥ 32 weeks and post-conceptional age ≥ 45 weeks
• First BRUE (no previous BRUE ever and not occurring in clusters)
• Duration of event < 1 minute
• No CPR required by trained medical provider
• No concerning historical features
• No concerning physical examination findings

In those infants classified as lower risk, the AAP does not recommend the use of home cardiorespiratory monitoring, noting “Clinicians Should Not Initiate Home Cardiorespiratory Monitoring in Infants Presenting with a Lower-Risk BRUE (Grade B, Moderate Recommendation).” While AAP does not recommend the use of home cardiorespiratory monitoring, it is noted this recommendation may result in missing an infant with recurrent central apnea or cardiac arrhythmias. In those infants determined to be higher risk, the guideline notes, “Although it is beyond the scope of this clinical practice guideline, future research may show that home monitoring (cardiorespiratory and/or oximetry) is appropriate for some infants with higher-risk BRUE.” The 2017 guidelines by the AAP and the American College of Obstetricians and Gynecologists (ACOG) notes “home cardiorespiratory monitors should not be used to justify discharge of infants who are still at risk of apnea solely because of immature respiratory control”.

It is recognized that the later sibling(s) of an infant who died of SIDS presents a unique emotional and clinical dilemma. Many clinicians suggest monitoring such infants until they are 1 month older than the age at which the sibling died and remain event-free. Although such use is not directly supported by specific evidence in the peer reviewed medical literature, it may be impossible to preclude monitoring if one or more siblings has died of SIDS. Short-term monitoring to assist in the family transition to home may be indicated in some cases following a previous sibling death from SIDS or following a particularly complex and protracted neonatal hospital course.

Types of Apnea

There are three types of infantile apnea: central, obstructive, and mixed.

Central Apnea: Central apnea is characterized by complete cessation of respiratory efforts on the monitor and is usually related to central nervous system injury, very premature infants in whom the respiratory center in the brain is immature, depressant medications (for example, narcotics, sedatives), or metabolic conditions (for example, hypoglycemia). The chest is still and no air passes through the nose or mouth.

Obstructive Apnea: A common type of apnea in children, obstructive apnea is caused by an obstruction of the airway (such as enlarged tonsils and adenoids) and is most likely to happen during sleep when the soft tissue at the back of the throat is most relaxed. In obstructive apnea, there is no airflow below the glottis though the monitor will continue to demonstrate breathing movements. The chest is moving, but no air passes through the nose or mouth. Infant home monitoring may identify heart rate changes that can accompany episodes of obstructive apnea.

Mixed Apnea: Mixed apnea is a combination of central and obstructive apnea and is seen particularly in infants or young children who have abnormal control of breathing. Mixed apnea may occur when a child is awake or asleep.

Monitors that are equipped with an event recorder are able to capture and store data surrounding significant events, such as heart rate and rhythm abnormalities, for later analysis by a physician. If home cardiorespiratory monitoring is prescribed, the monitor should be equipped with an event recorder. Information from the monitor can be used to distinguish the type of apnea and allow for a distinct treatment plan based on the etiology.

Peer Reviewed Publications:

1. Freed GE, Meny R, Glomb WB, Hageman JR. Effect of home monitoring on a high-risk population. J Perinatol. 2002; 22(2):165-167.
2. Halbower AC. Pediatric home apnea monitors: coding, billing, and updated prescribing information for practice management. Chest. 2008; 134(2):425-429.
3. Hoppenbrouwers T, Hodgman JE, Ramanathan A, Dorey F. Extreme and conventional cardiorespiratory events and epidemiologic risk factors for SIDS. J Pediatr. 2008; 152(5):636-641.
4. Jobe AH. What do home monitors contribute to the SIDS problem? JAMA. 2001; 285(17):2244-2245.
5. Lorch SA, Srinivasan L, Escobar GJ. Epidemiology of apnea and bradycardia resolution in premature infants. Pediatrics. 2011; 128(2):e366-e373.
6. Naulaers G, Daniels H, Alleqaert K, et al. Cardiorespiratory events recorded on home monitors: the effect of prematurity on later serious events. Acta Paediatr. 2007; 96(2):195-198.
7. Ramanathan R, Corwin MJ, Hunt CE, et al. Cardiorespiratory events recorded on home monitors: comparison of healthy infants with those at increased risk for SIDS. JAMA. 2001; 285(17):2199-2207.
8. Silvestri JM. Indications for home apnea monitoring (or not). Clin Perinatol. 2009; 36(1):87-99.
9. Strehle EM, Gray WK, Gopisetti S, et al. Can home monitoring reduce mortality in infants at increased risk of sudden infant death syndrome? A systematic review. Acta Paediatr. 2012; 101(1):8-13.

Government Agency, Medical Society, and Other Authoritative Publications:

1. American Academy of Pediatrics (AAP). Committee on Fetus and Newborn. Hospital discharge of the high-risk neonate. Pediatrics. 2008; 122(5):1119-1126. Reaffirmed 2018.
2. AAP Task Force on Sudden Infant Death Syndrome. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics. 2005; 116(5):1245-1255.
3. AAP. Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: updated 2016 Recommendations for a Safe Infant Sleeping Environment. Pediatrics. 2016; 138(5): e20162938
4. American College of Obstetricians and Gynecologists (ACOG)/AAP. Guidelines for perinatal care. Eighth Edition. 2017. Available at: https://publications.aap.org/aapbooks/book/522/Guidelines-for-Perinatal-Care?autologincheck=redirected. Accessed on April 25, 2026.
5. Eichenwald EC; Committee on Fetus and Newborn. Clinical report guidance for the clinician in rendering pediatric care. Apnea of Prematurity. January 2016. Pediatrics. 2016; 137(1):e20153757.
6. Moon RY, Carlin RF, Hand I; Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn. Sleep-related infant deaths: updated 2022 recommendations for reducing infant deaths in the sleep environment. Pediatrics. 2022;150(1):e2022057990.
7. Tieder JS, Bonkowsky JL, Etzel RA, et al.; Subcommittee on Apparent Life Threatening Events. Brief resolved unexplained events (formerly apparent life-threatening events) and evaluation of lower-risk infants. Pediatrics. 2016; 137(5).

1. American Academy of Pediatrics (AAP). The Truth about Home Apnea Monitors for SIDs. Last updated August 22, 2017. Available at: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/Home-Apnea-Monitors-for-SIDs.aspx. Accessed on March 12, 2026.
2. Medline Plus. Home apnea monitor use-infants. Reviewed July 1, 2025. Available at: https://medlineplus.gov/ency/patientinstructions/000755.htm. Accessed on March 12, 2026.
3. National Institute of Child Health and Human Development (NICHD). Safe to sleep campaign. Available at: https://safetosleep.nichd.nih.gov/. Accessed on March 12, 2026.

Apnea
Apnea Monitor
Apparent Life Threatening Event (ALTE)
Brief Resolved Unexplained Events (BRUE)
Home Cardiorespiratory Monitor
Infant Home Apnea Monitors
SIDS
Sudden Infant Death Syndrome

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