Obstructive sleep apnea
Also known as: OSA · sleep apnea · sleep-disordered breathing
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Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea
American Academy of Sleep Medicine (AASM) · 2017
AASM's guideline on how adult obstructive sleep apnea should be diagnosed, setting out when attended in-laboratory polysomnography versus home sleep apnea testing is appropriate.
- Questionnaires and prediction algorithms alone are not considered sufficient to diagnose OSA without objective sleep testing. source
- Polysomnography is recommended rather than home testing for patients with significant cardiorespiratory or neuromuscular conditions, and after a negative or inadequate home study. source
European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea
European Respiratory Society (ERS) · 2021
An ERS guideline covering treatment alternatives to CPAP in adults with obstructive sleep apnoea, developed by a multidisciplinary panel using GRADE across eight clinical questions.
US vs EU key differences
- The two documents barely overlap: the AASM guideline covers diagnostic testing only (polysomnography versus home sleep apnoea testing), while the ERS guideline covers only non-CPAP treatment alternatives. source
- AASM makes two strong diagnostic calls the European document does not touch: questionnaires and prediction algorithms such as STOP-BANG or Epworth must not establish an OSA diagnosis on their own, and a negative, inconclusive or technically inadequate home sleep test must be followed by polysomnography rather than a repeat home test. source
- AASM strongly requires in-laboratory polysomnography rather than home testing in patients with significant cardiorespiratory disease, possible respiratory muscle weakness, suspected hypoventilation, chronic opioid use, prior stroke or severe insomnia. source
- The ERS guideline gives device-specific limits absent from US diagnostic guidance: hypoglossal nerve stimulation is not first-line and is a salvage option only for CPAP- and mandibular-device-intolerant patients with AHI below 50 and BMI below 32, and carbonic anhydrase inhibitors should be used only within trials. source
- Certainty of evidence contrasts sharply: most AASM diagnostic recommendations are graded STRONG, whereas the ERS non-CPAP recommendations are almost all based on very low certainty evidence. source
What changed recently
- EU2011 ERS statement → 20212021-12-01
The 2021 document upgrades the 2011 ERS statement on non-CPAP therapies into a full GRADE-based clinical guideline, answering eight clinical questions on bariatric surgery, mandibular advancement devices, hypoglossal nerve stimulation, myofunctional therapy, maxillomandibular osteotomy, drug treatment and positional therapy. Hypoglossal nerve stimulation is newly covered as a therapy that entered practice after 2011, while isolated soft palate surgery was left out for lack of new evidence.
- US2005 and 2007 AASM practice parameters → 20172017-03-15
The 2017 guideline merges and replaces the 2005 practice parameters on indications for polysomnography and the 2007 clinical guideline on unattended portable monitors, setting out when home sleep apnoea testing is acceptable versus when polysomnography is required. It restricts home testing to uncomplicated patients with clinical signs of increased risk of moderate-to-severe OSA, specifies minimum technical requirements for home testing devices, and adds guidance on repeat testing after a negative or inconclusive study.
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