Monday, 18 Mar 2019

You are here

New Sleep Medicine Guidelines for Obstructive Sleep Apnea

The American Academy of Sleep Medicine (AASM) has established new guidelines for the evaluation and treatment of sleep-disordered breathing in adults, specifically guiding the use of positive airway pressure (PAP) in the treatment of obstructive sleep apnea (OSA) in adults. 

An AASM commissioned task force of sleep medicine experts undertook a systematic literature review, and developed consensus guidelines using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process.

Good Practice Statements 

  • Treatment of OSA with PAP therapy should be based on a diagnosis of OSA established using objective sleep apnea testing
  • Adequate follow-up, including troubleshooting and monitoring of objective efficacy and usage data to ensure adequate treatment and adherence, should occur following PAP therapy initiation and during treatment of OSA

Specific Recommendations

  1. We recommend that clinicians use PAP, compared to no therapy, to treat OSA in adults with excessive sleepiness. (STRONG)
  2. We suggest that clinicians use PAP, compared to no therapy, to treat OSA in adults with impaired sleep-related quality of life. (CONDITIONAL)
  3. We suggest that clinicians use PAP, compared to no therapy, to treat OSA in adults with comorbid hypertension. (CONDITIONAL)
  4. We recommend that PAP therapy be initiated using either APAP at home or in-laboratory PAP titration in adults with OSA and no significant comorbidities. (STRONG)
  5. We recommend that clinicians use either CPAP or APAP for ongoing treatment of OSA in adults. (STRONG)
  6. We suggest that clinicians use CPAP or APAP over BPAP in the routine treatment of OSA in adults. (CONDITIONAL)
  7. We recommend that educational interventions be given with initiation of PAP therapy in adults with OSA. (STRONG)
  8. We suggest that behavioral and/or troubleshooting interventions be given during the initial period of PAP therapy in adults with OSA. (CONDITIONAL)
  9. We suggest that clinicians use telemonitoring-guided interventions during the initial period of PAP therapy in adults with OSA. (CONDITIONAL)
Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Pain Drives the Use of Medical Marijuana

A report from the University of Michigan examined state-wide medical marijuana showing most of it is used for chronic pain.

The authors include Kevin Boehnke, Ph.D., Daniel J. Clauw, M.D., Rebecca L. Haffajee, Ph.D., and Saurav Gangopadhyay, M.P.H. undertook this investigation to to assess why people are using cannabis medically. 

Compounded Pain Creams - Expensive Placebos?

The Annals of Internal Medicine reports that the growth and use of compounded pain creams is unwarranted as they were no better than placebo in a randomized controlled trial, suggesting their higher costs are unjustifiable compared to other topical commercially available agents (lidocaine, diclofenac, capsaicin, etc.). (Citation source: https://buff.ly/2BkTj58)

Opioids Double Rates of Suicides and Overdoses

An article in the New England Journal of Medicine reports that the rates of suicide and drug overdoses has doubled in the last 17 years, and that opioids are largely to blame.

Using data from the Centers for Disease Control and Prevention databases, researchers show that the sheer number of deaths from suicides and unintentional overdoses together rose from 41,364 in the year 2000 to 110,749 in 2017.

Cryotherapy Never FDA Approved

Another injury related to whole body cryotherapy (WBC) has been reported by practitioners in Philadelphia, serving as yet another warning of WBC's potential to cause serious adverse effects.

Post-Approval Exploratory Trials with Pregabalin Often Fail

A systematic review of 238 pregabalin (Lyrica) trials for nonapproved indications shows that nearly two-thirds yielded uncertain evidence of efficacy, thereby questioning the off-label use or endorsement in clinical practice guidelines.