Professional Statements and Societal Positions Guidelines
American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) 2016
The American Academy of Otolaryngology-Head and Neck Surgery considers upper airway stimulation (UAS) via the hypoglossal nerve for the treatment of adult obstructive sleep apnea syndrome to be an effective second-line treatment of moderate to severe obstructive sleep apnea in [individuals] who are intolerant or unable to achieve benefit with positive pressure therapy (PAP). Not all adult [individuals] are candidates for UAS therapy and appropriate polysomnographic, age, BMI and objective upper airway evaluation measures are required for proper individual selection.
American Academy of Pediatrics (AAP) - 2012
The American Academy of Pediatrics published guidelines on the diagnosis and management of uncomplicated childhood OSA associated with adenotonsillar hypertrophy and/or obesity in an otherwise healthy [pediatric individual] treated in the primary care setting, which updated the AAP's 2002 guidelines. AAP recommended that all [pediatric individuals] or adolescents be screened for snoring, and PSG is performed in [pediatric individuals] or adolescents with snoring and symptoms or signs of OSA as listed in the guideline. If PSG is not available, an alternative diagnostic test or referral to a specialist may be considered (option). The estimated prevalence rates of OSA in [pediatric individuals] ranged from 1.2 percent to 5.7 percent. Adenotonsillectomy was recommended as the first-line treatment for individuals with adenotonsillar hypertrophy, and individuals should be reassessed clinically postoperatively to determine whether additional treatment is required. High-risk individuals should be reevaluated with an objective test or referred to a sleep specialist. CPAP was recommended if adenotonsillectomy was not performed or if OSA persisted postoperatively. Weight loss was recommended in addition to other therapy in individuals who are overweight or obese, and intranasal corticosteroids are an option for [pediatric individuals] with mild OSA in whom adenotonsillectomy is contraindicated or for mild postoperative OSA.
American Academy of Sleep Medicine (AASM)
Oral Appliance Therapy – 2015
The AASM along with the American Academy of Dental Sleep Medicine (AADSM) engaged a seven member task force for the treatment of OSA and snoring with oral appliance therapy developed recommendations and assigned strengths based on the quality of the evidence counterbalanced by an assessment of the relative benefit of the treatment versus the potential harms. The AASM and AADSM Board of Directors approved the final guideline recommendations.
- We suggest that sleep physicians conduct follow-up sleep testing to improve or confirm treatment efficacy, rather than conduct follow-up without sleep testing, for [individuals] fitted with oral appliances.
Use of Actigraphy in Adult and Pediatric [Individuals] – 2018
The following AASM recommendations are intended as a guide for clinicians using actigraphy in evaluating [individuals] with sleep disorders and circadian rhythm sleep-wake disorders, and only apply to the use of FDA-approved devices. Each recommendation statement is assigned a strength (“Strong” or “Conditional”). A “Strong” recommendation (i.e., “We recommend…”) is one that clinicians should follow under most circumstances. A “Conditional” recommendation (i.e., “We suggest…”) reflects a lower degree of certainty regarding the outcome and appropriateness of the individual-care strategy for all [individuals]. The ultimate judgment regarding any specific care must be made by the treating clinician and the individual, taking into consideration the individual circumstances of the individual, available treatment options, and resources.
- Suggest clinicians use actigraphy in the assessment of pediatric [individuals] with insomnia disorder.
- Suggest clinicians use actigraphy in the assessment of adult [individuals] with circadian rhythm sleep-wake disorder. (Conditional) 4. We suggest that clinicians use actigraphy in the assessment of pediatric [individuals] with circadian rhythm sleep-wake disorder.
- Suggest clinicians use actigraphy to monitor total sleep time prior to testing with the Multiple Sleep Latency Test in adult and pediatric [individuals] with suspected central disorders of hypersomnolence.
- Recommend clinicians not use actigraphy in place of electromyography for the diagnosis of periodic limb movement disorder in adult and pediatric [individuals].
Treatment of OSA with PAP Therapy – 2019
Based on expert consensus from the AASM, the following good practice statements and their implementation is necessary for appropriate and effective management of [individuals] with OSA treated with positive airway pressure:
- 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.