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Review
. 2017;21(4):290-301.
doi: 10.1007/s11818-017-0136-2. Epub 2017 Nov 7.

German S3 Guideline Nonrestorative Sleep/Sleep Disorders, Chapter "Sleep-Related Breathing Disorders in Adults," Short Version: German Sleep Society (Deutsche Gesellschaft Für Schlafforschung Und Schlafmedizin, DGSM)

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Review

German S3 Guideline Nonrestorative Sleep/Sleep Disorders, Chapter "Sleep-Related Breathing Disorders in Adults," Short Version: German Sleep Society (Deutsche Gesellschaft Für Schlafforschung Und Schlafmedizin, DGSM)

Geert Mayer et al. Somnologie (Berl). .
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Figures

Fig. 1
Fig. 1
Algorithm for management of patients with suspected obstruction of the upper airways. Following exclusion of medical and psychological diseases requiring optimization and in the presence of a high pretest probability, i. e., daytime sleepiness plus breathing pauses plus snoring, polygraphy of cardiorespiratory parameters can be a sufficient diagnostic instrument. In the case of a low pretest probability, polysomnography (PSG) is performed for differential diagnosis. (AHI apnea–hypopnea index, OSA obstructive sleep apnea, CSA central sleep apnea)
Fig. 2
Fig. 2
Algorithm for management of patients with cardiovascular diseases. Around 50% of patients with cardiovascular disease are also affected by a sleep-related breathing disorder. Therefore, in asymptomatic cardiovascular patients, monitoring for sleep-related breathing disorders can be performed with simplified systems with 1–3 channels. If symptoms of sleep-related breathing disorders are present, polygraphy or polysomnography is indicated. (CNS central nervous system, OSA obstructive sleep apnea, CSA central sleep apnea)
Fig. 3
Fig. 3
Algorithm for treatment of patients with obstructive sleep apnea. *Patient training, behavioral recommendations, sleep medicine counselling; in overweight patients, weight reduction should be attempted in parallel. **In patients with an apnea–hypopnea index (AHI) ≤30/h and lifelong obstructive sleep apnea (OSA), positional therapy can be considered if no other therapy is possible or tolerated. Mandibular advancement devices (MAD) can also be considered in patients with severe sleep apnea who do not tolerate or refuse continuous positive airway pressure (CPAP), or in whom CPAP therapy cannot be used despite utilisation of all support measures. Where positive airway pressure therapies or MAD fail, in the absence of anatomic abnormalities and the presence of an AHI of 15–50/h, neurostimulation of the hypoglossal nerve (NSHG) can be used up to class I obesity, provided there is no concentric obstruction of the airways. (OSAS obstructive sleep apnea syndrome, APAP automatic CPAP)
Fig. 4
Fig. 4
Algorithm for management of patients with suspected central sleep apnea. *Upon unclear findings in polygraphy, polysomnography is performed for differential diagnosis. (CSA central sleep apnea, CPAP continuous positive airway pressure, ASV adaptive servoventilation, CNS central nervous system, OSA obstructive sleep apnea, EF ejection fraction)

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