A new clinical practice guideline from the American Academy of Sleep Medicine (AASM) provides guidance to clinicians on the use of positive airway pressure (PAP) therapy to treat obstructive sleep apnea (OSA) in adults.
The guideline, published in the Feb 15 issue of the Journal of Clinical Sleep Medicine, provides nine recommendations for PAP treatment of OSA in adults and is intended for use in conjunction with other AASM guidelines in the evaluation and treatment of sleep-disordered breathing. It includes 4 strong recommendations, which clinicians should follow under most circumstances:
- We recommend that clinicians use PAP, compared to no therapy, to treat OSA in adults with excessive sleepiness.
- We recommend that PAP therapy be initiated using either auto-adjusting PAP (APAP) at home or in-laboratory PAP titration in adults with OSA and no significant comorbidities.
- We recommend that clinicians use either continuous PAP (CPAP) or APAP for ongoing treatment of OSA in adults.
- We recommend that educational interventions be given with initiation of PAP therapy in adults with OSA.
“We, as the task force, believe that readers will find the guideline of value in further supporting the need to use PAP therapy for treatment of adults with obstructive sleep apnea who are excessively sleepy, have concomitant hypertension, or have impaired sleep-related quality of life,” says lead author Susheel P. Patil, MD, PhD, an assistant professor of medicine and clinical director of the Johns Hopkins Sleep Medicine Program in Baltimore, in a release. “Furthermore, we hope the guideline provides the rationale for providers, health systems, and payors to establish programs that promote early and sustained adherence to PAP therapy for the benefit of patients experiencing the consequences of obstructive sleep apnea.”
Developed by an expert task force and approved by the AASM board of directors, the guideline updated and consolidated previously published practice parameters and was based on a systematic literature review, meta-analyses, and assessment of the evidence using the GRADE methodology. A draft of the guideline was previously made available for public comment.
The guideline includes two good practice statements that the task force considered to be necessary for appropriate and effective patient care: Treatment of OSA with PAP therapy should be based on a diagnosis of OSA established using objective sleep apnea testing, and adequate follow-up should occur following PAP therapy initiation and during treatment of OSA. The guideline also provides 5 conditional recommendations, which reflect a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients.
- We suggest that clinicians use PAP, compared to no therapy, to treat OSA in adults with impaired sleep-related quality of life.
- We suggest that clinicians use PAP, compared to no therapy, to treat OSA in adults with comorbid hypertension.
- We suggest that clinicians use CPAP or APAP over bilevel PAP (BPAP) in the routine treatment of OSA in adults.
- We suggest that behavioral and/or troubleshooting interventions be given during the initial period of PAP therapy in adults with OSA.
- We suggest that clinicians use telemonitoring-guided interventions during the initial period of PAP therapy in adults with OSA.
“Untreated obstructive sleep apnea can have a detrimental impact on a patient’s health, well-being, and quality of life,” says AASM president Douglas Kirsch, MD. “When obstructive sleep apnea is effectively treated with PAP therapy, many patients report that the impact is life-changing.”
The task force found that additional research is needed to evaluate the impact of PAP therapy on cardiovascular risk, neurocognition, and mortality. Patil added that a section with additional considerations for clinicians summarizes the evidence with respect to mask selection, humidified PAP, and modified pressure profile PAP—factors that he says may have important implications for clinical practice.
This is what the AASM spends their time and our dollars on? Recommending PAP instead of nothing for someone with OSA! This has to be a joke. How about helping us work with the insurance companies on split night protocols so we don’t get denied after the service! Do something useful.
Amen.
I agree with working with the insurance companies to get us a CPT code for split night studies. The denials when the patients do not split is getting out of hand as most of the time it is out of our control.
I am disappointed in no mention of OAT. The other guidelines before mentioned if patients were struggling with PAP therapy “no treatment is an option” therefore OAT is an alternative. Why in the world with the studies that have been done over the last 3-5 years AASM still doesn’t recommend working with a trained certified Dentist to make an Oral appliance that patients are compliant in wearing and they CAN be just as effective or really close with many patients. Why is Inspire successful— it holds the tongue forward, therefore an OA does exactly the same thing! Hello? What are you not getting?
agree— but would also like to see the measure of effectiveness be measured equal as in 5 or less AHI… not 10 — and making sure patients that are severe AHI know that success for them is called cutting the AHI in half-not getting them below 5…
Having said that, I am a believer that OATS have a place in sleep therapy options !
If a patient is non compliant with PAP therapy then an alternative is an or oral sleep appliance which has proven in many studies to be an effective alternative in mild
And moderate sleep apnea cases.Please let you readers know this is a viable an effective treatment but of course not as effective as CPAP which is the gold
Standard . My best,Ronald T Plotka DDS
How about working with insurances on allowing cpap titrations to be done in the lab, instead of requiring auto-cpap prescriptions. Most patients are not compliant if they didn’t have the study in the office. Also a lot of patient are under diagnosed because of home sleep studies. Also, how about allowing to perform home sleep studies only to sleep doctors and not to anyone who decide to make an extra buck. What’s the point of being AASM CERTIFIED then?
Agree!!
CPAP instead of nothing! Amazing!
What is the next thing!
Cross at the green light and not the red!
lets do some heavy lifting and get some insurance companies to be human in approving in lab- lets stop being conflicted by grant-speaking money and lets level with folks that an HST is NOT an in lab study -If I use HST and am awake for 9 of 10 hours recording, then sleep for the hour and have 40 apneas in that hour — my index is 4 per hour on the HST and I am denied CPAP! yet this passes as a good way to test… that’s if you even know who used the unit !