New Guidelines for the Diagnosis of Sleep Apnea

The American Academy of Sleep Medicine (AASM) announced a new clinical practice guideline for the diagnosis of obstructive sleep apnea (OSA) in adults. The full guideline, developed by an expert task force of board-certified sleep medicine physicians, is published in the Journal of Clinical Sleep Medicine.¹

The clinical practice recommendations were based on a systematic literature review, meta-analyses, and assessment of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. The guideline includes circumstances when an attended polysomnography in an accredited sleep center or home sleep apnea testing should be done for suspected obstructive sleep apnea. 

The guideline contains updated recommendations from previous practice parameters and guidelines published in 2005 and 2007. Two “good practice statements” were adopted by the task force as the foundation for high quality care when diagnosing obstructive sleep apnea: 1) diagnostic testing for obstructive sleep apnea should be conducted along with a comprehensive sleep evaluation and adequate follow-up; and 2) polysomnography is the standard diagnostic test for adults in whom obstructive sleep apnea is suspected based on a comprehensive sleep evaluation.

The following 6 recommendations were developed to guide clinicians in diagnosing obstructive sleep apnea in adults:

• Clinical tools, questionnaires and prediction algorithms should not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (Grade: Strong)
• Polysomnography, or home sleep apnea testing with a technically adequate device, should 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. (Grade: Strong)
• If a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography should be performed for the diagnosis of OSA. (Grade: Strong)
• Polysomnography, rather than home sleep apnea testing, should 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. (Grade: Strong)
• If clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography should be used for the diagnosis of OSA. (Grade: Weak)
• When the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram should be considered for the diagnosis of OSA. (Grade: Weak) 

The task force emphasizes that home sleep apnea testing should be given by an accredited sleep center under the supervision of a board-certified sleep medicine physician or a board-eligible sleep medicine provider. Also, if anyone experiences warning signs of sleep apnea (eg, snoring, gasping, choking during sleep), they should discuss these symptoms with a doctor. 

AASM President Dr. Ronald D. Chervin added, “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.”

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Reference

1. Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017;13(3):479-504.

This article originally appeared on MPR