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. 2021 Dec 1;17(12):2499-2505.
doi: 10.5664/jcsm.9592.

Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine clinical practice guideline

David Kent  1 , Jeffrey Stanley  2 , R Nisha Aurora  3 , Corinna Levine  4 , Daniel J Gottlieb  5 , Matthew D Spann  1 , Carlos A Torre  4 , Katherine Green  6 , Christopher G Harrod  7
Affiliations

Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine clinical practice guideline

David Kent et al. J Clin Sleep Med. .

Abstract

Introduction: This guideline establishes clinical practice recommendations for referring adults with obstructive sleep apnea (OSA) for surgical consultation.

Methods: The American Academy of Sleep Medicine (AASM) commissioned a task force of experts in sleep medicine, otolaryngology, and bariatric surgery to develop recommendations and assign strengths based on a systematic review of the literature and an assessment of the evidence using the GRADE process. The task force evaluated the relevant literature and the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations that support the recommendations. The AASM Board of Directors approved the final recommendations.

Recommendations: The following recommendations are intended as a guide for clinicians who treat adults with OSA. Each recommendations statement is assigned a strength ("Strong" or "Conditional"). A "Strong" recommendation (ie, "We recommend…") is one that clinicians should follow under most circumstances. A "Conditional" recommendation is one that requires that the clinician use clinical knowledge and experience and strongly consider the patient's values and preferences to determine the best course of action. (1) We recommend that clinicians discuss referral to a sleep surgeon with adults with OSA and BMI <40 kg/m2 who are intolerant or unaccepting of PAP as part of a patient-oriented discussion of alternative treatment options (STRONG). (2) We recommend that clinicians discuss referral to a bariatric surgeon with adults with OSA and obesity (class II/III, BMI ≥35 kg/m2) who are intolerant or unaccepting of PAP as part of a patient-oriented discussion of alternative treatment options (STRONG). (3) We suggest that clinicians discuss referral to a sleep surgeon with adults with OSA, BMI <40 kg/m2, and persistent inadequate PAP adherence due to pressure-related side effects as part of a patient-oriented discussion of adjunctive or alternative treatment options (CONDITIONAL). (4) We suggest that clinicians recommend PAP as initial therapy for adults with OSA and a major upper airway anatomic abnormality prior to consideration of referral for upper airway surgery (CONDITIONAL).

Citation: Kent D, Stanley J, Aurora RN, et al. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021;17(12):2499-2505.

Keywords: bariatric surgery; hypoglossal nerve stimulation; maxillomandibular advancement; obstructive sleep apnea; upper airway surgery.

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Conflict of interest statement

The development of this paper was funded by the American Academy of Sleep Medicine (AASM). Dr. David Kent is listed as an inventor on U.S. and international patent applications regarding surgical treatments for OSA owned and licensed by Vanderbilt University (VU) to Nyxoah SA. Dr. Kent receives a portion of any licensing revenues as per standard VU technology transfer policy. The licensed treatment methodologies do not currently exist in prototype or commercial form and are not represented in the surgical literature reviewed by the TF. The licensing agreement was completed in early 2021, after completion of the initial clinical practice guideline, supporting systematic review, and public comment period. Mr. Harrod is employed by the AASM. The other authors report no conflicts of interest.

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