Use of polysomnography and home sleep apnea tests for the longitudinal management of obstructive sleep apnea in adults: an American Academy of Sleep Medicine clinical guidance statement

Abstract

Introduction: Obstructive sleep apnea is an important and common disorder with associated health risks. Assuring successful longitudinal management is vital to patient health and sleep-related quality of life. This paper provides guidance from the American Academy of Sleep Medicine (AASM) regarding the use of polysomnography (PSG) and home sleep apnea tests (HSATs) after a diagnosis of obstructive sleep apnea has been established and, in most cases, treatment implemented. Methods: The AASM commissioned a task force of five sleep medicine experts. A literature search was conducted to identify studies that included adult patients with OSA who underwent follow-up PSG or an HSAT. The task force developed clinical guidance statements based on a review of these studies and expert opinion. The AASM Board of Directors approved the final clinical guidance statements. Clinical Guidance Statements: The AASM supports the following clinical guidance statements on indications for follow-up PSG and HSAT in adult patients with OSA.1. Follow-up PSG or HSAT is not recommended for routine reassessment of asymptomatic patients with obstructive sleep apnea on PAP therapy, however, follow-up PSG or HSAT can be used to reassess patients with recurrent or persistent symptoms, despite good PAP adherence. 2. Follow-up PSG or HSAT is recommended to assess response to treatment with non-PAP interventions. 3. Follow-up PSG or HSAT may be used if clinically significant weight gain or loss has occurred since diagnosis of OSA or initiation of its treatment. 4. Follow-up PSG may be used for reassessment of sleep-related hypoxemia and/or sleep-related hypoventilation following initiation of treatment for OSA. 5. Follow-up PSG or HSAT may be used in patients being treated for OSA who develop or have a change in cardiovascular disease. 6. Follow-up PSG may be used in patients with unexplained PAP device-generated data. The ultimate judgment regarding propriety of any specific care must be made by the clinician, in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options and resources.

Comorbid Major Depressive Disorder and Obstructive Sleep Apnea

“…Finally, a confirmatory test is required to verify the OSA diagnosis. The test consists of PSG or home sleep apnea test (HAST), according to American Academy of Sleep Medicine (AASM) guidelines [ 22 , 23 ].…”

“…[ 32 ] A CPAP education with troubleshooting management remains the standard treatment to provide all OSA patients with CPAP treatment to improve CPAP adherence. [ 23 , 33 ] Effects of the use of selective serotonin reuptake inhibitors (SSRIs) on OSA symptoms are unclear. Theoretically, SSRIs function through serotoninergic neurotransmission, resulting in the suppression of REM sleep and increasing the function of the upper airway dilator muscle, which may reduce upper airway collapsibility.…”

“…A CPAP education with troubleshooting management remains the standard treatment to provide all OSA patients with CPAP treatment to improve CPAP adherence. [ 23 , 33 ]…”

Brazilian Thoracic Association Consensus on Sleep-disordered Breathing

“…A reavaliação de rotina não é indicada para todos os pacientes; porém, pacientes sob tratamentos alternativos a CPAP, como dispositivo de avanço mandibular, terapia posicional, cirurgia ou perda de peso, podem se beneficiar da reavaliação. (144) A oximetria de alta resolução (tipo 4) detecta oscilações cíclicas da SpO 2 que tipicamente acompanham os eventos respiratórios. Estudos recentes demonstram uma alta correlação entre o IAH derivado da PSG e o índice de dessaturação de oxigênio tanto quando analisado como um canal independente da PSG como através de oxímetros de alta resolução.…”

Smart Multiparameter Infant Apnoea Monitor

“…Several innovative approaches have been previously used in the design of apnoea monitors. The gold standard for apnoea diagnosis is the use of polysomnography (PSG) [15] [16]. PSG involves continuous, simultaneous multi-channel measurements of eight different physiological signals, including oronasal flow, oxygen saturation and heart rate, electroencephalography (EEG, brain waves), electrooculography (EOG, eye movements), chin electromyography (muscle activity), electrocardiography (ECG), respiratory effort and airflow.…”