AASM publishes clinical practice guideline on use of PAP therapy for sleep apnea

Feb. 19, 2019

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 four strong recommendations which clinicians should follow under most circumstances:

  • Clinicians should use PAP, compared to no therapy, to treat OSA in adults with excessive sleepiness.
  • Initiate PAP therapy using either auto-adjusting PAP (APAP) at home or in-laboratory PAP titration in adults with OSA and no significant comorbidities.
  • Clinicians should use either continuous PAP (CPAP) or APAP for ongoing treatment of OSA in adults.
  • Give educational interventions with initiation of PAP therapy in adults with OSA.

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 five conditional recommendations, which reflect a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients.

  • Clinicians should use PAP, compared to no therapy, to treat OSA in adults with impaired sleep-related quality of life.
  • Clinicians should use PAP, compared to no therapy, to treat OSA in adults with comorbid hypertension.
  • Clinicians should use CPAP or APAP over bilevel PAP (BPAP) in the routine treatment of OSA in adults.
  • Behavioral and/or troubleshooting interventions should be given during the initial period of PAP therapy in adults with OSA.
  • Clinicians should use telemonitoring-guided interventions during the initial period of PAP therapy in adults with OSA.

AASM has the full release.