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Clinical Practice Guidelines

American Academy of Sleep Medicine

Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults

Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD. J Clin Sleep Med 2009; 5 (3): 263-276

This guideline was developed by the American Academy of Sleep Medicine (AASM) in 2009 to assist providers who care for patients with obstructive sleep apnea (OSA) with the evaluation, management and long-term care of their patients.

The authors highlighted the following recommendations:

  • “The diagnostic strategy includes a sleep-oriented history and physical examination, objective testing, and education of the patient. The presence or absence and severity of OSA must be determined before initiating treatment in order to identify those patients at risk of developing the complications of sleep apnea, guide selection of appropriate treatment, and to provide a baseline to establish the effectiveness of subsequent treatment.”
  • “Once the diagnosis is established, the patient should be included in deciding an appropriate treatment strategy that may include positive airway pressure devices, oral appliances, behavioral treatments, surgery, and/or adjunctive treatments.”
  • “All patients with OSA should have ongoing, long-term management for their chronic disorder. Those on chronic therapy (PAP, Oral Appliance, positional therapy) should have regular, ongoing follow-up to monitor adherence to therapy, side effects, development of medical complications related to OSA and continued resolution of symptoms.”

For each treatment option available at the time, the authors described appropriate outcome measures and long-term follow-up. The AASM continues to publish clinical practice recommendations on their website for use in conjunction with these guidelines.

Related Publications:

Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure: An American Academy of Sleep Medicine Clinical Practice Guideline

Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. J Clin Sleep Med. 2019; 15 (2): 335‐343

Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015

Ramar K, Dort LC, Katz SG, et al. J Clin Sleep Med. 2015; 11 (7): 773‐827

Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults

Aurora RN, Casey KR, Kristo D, et al. Sleep. 2010; 33 (10): 1408‐1413

Practice parameters for the medical therapy of obstructive sleep apnea

Morgenthaler TI, Kapen S, Lee-Chiong T, et al. Sleep. 2006; 29 (8): 1031‐1035

The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses

Aurora RN, Chowdhuri S, Ramar K, et al. Sleep. 2012; 35 (1): 17‐40

American College of Physicians

Management of obstructive sleep apnea in adults: A clinical practice guideline from the American College of Physicians

Qaseem A, Holty JE, Owens DK, Dallas P, Starkey M, Shekelle P, et al. Ann Intern Med. 2014; 161 (3): 210‐220

In 2014, the American College of Physicians (ACP) published a clinical practice guideline to provide clinical recommendations on the management of obstructive sleep apnea (OSA) in adults. The authors highlighted three recommendations, based on their review of literature published prior to 2012.

  1. “ACP recommends that all overweight and obese patients diagnosed with OSA should be encouraged to lose weight.
  2. “ACP recommends continuous positive airway pressure treatment as initial therapy for patients diagnosed with OSA.”
  3. “ACP recommends mandibular advancement devices as an alternative therapy to continuous positive airway pressure treatment for patients diagnosed with OSA who prefer mandibular advancement devices or for those with adverse effects associated with continuous positive airway pressure treatment.”