Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults

Abstract

Background: Obstructive sleep apnea (OSA) is a common chronic disorder that often requires lifelong care. Available practice parameters provide evidence-based recommendations for addressing aspects of care.

Objective: This guideline is designed to assist primary care providers as well as sleep medicine specialists, surgeons, and dentists who care for patients with OSA by providing a comprehensive strategy for the evaluation, management and long-term care of adult patients with OSA.

Methods: The Adult OSA Task Force of the American Academy of Sleep Medicine (AASM) was assembled to produce a clinical guideline from a review of existing practice parameters and available literature. All existing evidence-based AASM practice parameters relevant to the evaluation and management of OSA in adults were incorporated into this guideline. For areas not covered by the practice parameters, the task force performed a literature review and made consensus recommendations using a modified nominal group technique.

Recommendations: Questions regarding OSA should be incorporated into routine health evaluations. Suspicion of OSA should trigger a comprehensive sleep evaluation. The diagnostic strategy includes a sleep-oriented history and physical examination, objective testing, and education of the patient. The presence or absence and severity of OSA must be determined before initiating treatment in order to identify those patients at risk of developing the complications of sleep apnea, guide selection of appropriate treatment, and to provide a baseline to establish the effectiveness of subsequent treatment. Once the diagnosis is established, the patient should be included in deciding an appropriate treatment strategy that may include positive airway pressure devices, oral appliances, behavioral treatments, surgery, and/or adjunctive treatments. OSA should be approached as a chronic disease requiring long-term, multidisciplinary management. For each treatment option, appropriate outcome measures and long-term follow-up are described.

Figure 1

Evaluation. Flow chart for evaluation of patients suspected of having OSA. PCP = primary care physician, SS = sleep specialist.

Figure 2

CPAP Treatment. Approach to initiation, management, and follow-up of CPAP.

Figure 3

Behavioral Treatment. Approach to initiation, management, and follow-up of behavioral treatment.

Figure 4

Oral Appliances. Approach to initiation, management, and follow-up of patients using custom OA therapy.

Figure 5

Surgical Treatment. Approach to the management of OSA with surgical therapy.

Figure 6

Adjunctive Treatment. Approach to the management of OSA with adjunctive therapies