Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

Abstract

Introduction: This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. Methods: The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. Recommendations:The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements:Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation. Recommendations:1. We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG) 2. We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG) 3. We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG) 4. We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG) 5. We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protoc...

American Academy of Sleep Medicine Position Paper for the Use of a Home Sleep Apnea Test for the Diagnosis of OSA in Children

“…In contrast to the recently published AASM clinical practice guideline on the diagnostic testing for adult OSA, 3 an objective evaluation of the available literature does not support the use of HSATs for the diagnosis of OSA in children, due mostly to a lack of sufficient validation in the home, and insufficient monitoring available in most devices used to conduct an HSAT. The task force identified several areas for future research, including the need to define optimal physiologic parameters to be measured in individual patients, develop additional tools to assess sleep/wake status, validate an ideal HSAT device against PSG, create a diagnostic algorithm to identify ideal candidates for an HSAT, and establish appropriate alternatives to PSG.…”

“…There are also recently published AASM guidelines on the diagnostic testing for obstructive sleep apnea (OSA) which address the use of a home sleep apnea test (HSAT) in adults. 3 The readily available HSAT devices require significantly fewer resources than PSG, and may provide clinical benefit; however, the existing AASM guidelines do not offer recommendations on the use of an HSAT in the pediatric population (birth to 18 years of age). The AASM commissioned a task force of experts in pediatric sleep medicine to develop a position paper on the utility of an HSAT in this population, based on a review of the available literature and their clinical expertise (see Methodology in the supplemental material).…”

Complaints on Sleep Breathing Disorder and Cardiovascular Risk Factors in Russian Regions: Data From Esse-Rf Study

“…Ранее мы показали, что только наличие храпа не является прогностиче-ским признаком наличия апноэ во сне [6], нужно оценивать его частоту. Половые различия в частоте храпа у мужчин и женщин традиционно объясняют как различиями в оценке этого звукового феномена партнерами по сну, так и различиями в анатомии гор-таноглотки и гормонального статуса [7].…”

“…Последнее влияет на развитие син-дрома ОАС путем снижения активности подборо-дочно-язычной мышцы и других мышц верхних дыхательных путей. Необходимо помнить, что для антропометрических показателей, в отличие от сер-дечно-сосудистых заболеваний, наиболее значимым предиктором наличия апноэ является не окружность талии, а окружность шеи [7], которая не была вклю-чена в число оцениваемых показателей у участников ЭССЕ-РФ. Влияние возраста было сопоставимым для апноэ и храпа и не таким значимым -ОР 1,02 и 1,3, соответственно.…”

Clinical Use of a Home Sleep Apnea Test: An American Academy of Sleep Medicine Position Statement

“…Due to these limitations, an HSAT may underestimate the severity of OSA. 8 Although it is less sensitive than polysomnography in the detection of OSA, an HSAT can be ordered by a physician for the diagnosis of OSA when the physician has determined that the patient does not have other medical conditions or risk for other sleep disorders that would preclude the use of an HSAT and has identified signs and symptoms that indicate an increased risk of moderate to severe OSA, rather than mild OSA. 8 The management of OSA also may include a follow-up HSAT ordered by a physician to collect objective data that can help improve or confirm treatment efficacy.…”