The American Academy of Sleep Medicine has issued a new clinical practice guideline indicating when performing attended polysomnography in an accredited sleep center or at-home sleep apnea testing is appropriate for suspected obstructive sleep apnea in adults.
The recommendations, which are published in the March issue of the Journal of Clinical Sleep Medicine and were discussed during SLEEP 2017, the annual meeting of the Associated Professional Sleep Societies, are based on a systematic literature review, meta-analyses of assessment of quality of evidence, balance of benefits and harms, patient values and preferences and resource use.
The American Academy of Sleep Medicine (AASM) made six essential recommendations for diagnosing obstructive sleep apnea (OSA):
- Adults without an increased risk for non-obstructive sleep-disordered breathing but with an increased risk for OSA should be tested with polysomnography or home sleep apnea testing with a technically adequate device;
- Polysomnography should be conducted in symptomatic patients when a single home sleep apnea test is negative;
- Patients with significant cardiorespiratory disease, neuromuscular disease with respiratory muscle impairment, awake hypoventilation or high risk of sleep-related hypoventilation, chronic opioid medication use or severe insomnia should be tested with polysomnography, rather than home sleep apnea testing;
- A split-night diagnostic protocol, instead of a full-night diagnostic protocol for polysomnography should be used when clinically appropriate;
- Symptomatic patients should undergo a second polysomnogram when the initial polysomnogram is negative and OSA is still clinically suspected; and
- Clinical tools, questionnaires and prediction algorithms should not be used in the absence of objective sleep testing.
In addition, AASM provided two good practice statements that establish the basis for appropriate and effective diagnosis of OSA.
“This clinical practice guideline provides important recommendations for the diagnosis of obstructive sleep apnea, a chronic disease that afflicts millions of people in the U.S.,” Ronald D. Chervin, MD, MS, president of AASM, said in a related news release. “Because people who suffer from untreated sleep apnea have an increased risk of numerous health problems, including hypertension and cardiovascular disease, the accurate diagnosis of obstructive sleep apnea is essential for achieving optimal health through better sleep.”
The guideline is intended to be used in combination with other AASM recommendations on the evaluation and treatment of sleep-disordered breathing in adults, according to AASM. – by Alaina Tedesco
Kapur VK, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea; An update for 2016: An American Academy of Sleep Medicine clinical practice guideline. Presented at: SLEEP 2017; June 3-7; Boston.
Disclosure: AASM funded the development of this guideline.