Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline
Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline
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DOI：
10.5664/jcsm.6506
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发表时间：
2017-01-01
影响因子：
4.3
通讯作者：
Harrod, Christopher G.
中科院分区：
文献类型：
--
作者：
Kapur, Vishesh K.;Auckley, Dennis H.;Harrod, Christopher G.
简介：本指南建立了临床实践的建议，诊断阻塞性睡眠呼吸暂停（OSA）在成人中，并打算与其他美国睡眠医学学会（AASM）的指导方针的评估和治疗睡眠呼吸障碍的adult.Methods：AASM委托睡眠医学专家组成的工作组。进行了系统性综述以识别研究，并使用建议评估、开发和评价分级（GRADE）过程来评估证据。工作组根据证据质量、利益和危害的平衡、患者价值观和偏好以及资源使用情况制定了建议并分配了优势。此外，工作组还采纳了以前指南中的基本建议，作为“良好实践声明”，为OSA的适当和有效诊断奠定了基础。AASM董事会批准了最终建议。建议：以下建议旨在为临床医生诊断成人OSA提供指导。在GRADE下，强烈建议是临床医生在大多数情况下应该遵循的建议。弱建议反映了对所有患者的患者护理策略的结局和适当性的确定性较低。临床医生必须根据患者的具体情况、可用的诊断工具、可获得的治疗方案和资源，对任何具体护理的适当性做出最终判断。良好实践声明：OSA的诊断测试应与全面的睡眠评估和充分的随访相结合。多导睡眠图是诊断OSA的标准诊断测试，用于诊断基于全面睡眠评估的成人患者。建议：1.我们建议在没有多导睡眠图或家庭睡眠呼吸暂停测试的情况下，不要使用临床工具，问卷调查和预测算法来诊断成人OSA。（强）2.我们建议，多导睡眠图，或家庭睡眠呼吸暂停测试与技术上适当的设备，用于诊断OSA的无并发症的成年患者表现出的体征和症状，表明中度至重度OSA的风险增加。（强）3.我们建议，如果一个单一的家庭睡眠呼吸暂停测试是阴性的，不确定的，或技术上不充分，多导睡眠图进行诊断OSA。（强）4.我们建议多导睡眠图，而不是家庭睡眠呼吸暂停测试，用于诊断患有严重心肺疾病，神经肌肉状况导致的潜在呼吸肌无力，清醒通气不足或怀疑睡眠相关通气不足，慢性阿片类药物使用，中风史或严重失眠的患者的OSA。（强）我们建议，如果临床上适当的，分裂夜间诊断协议，而不是一个完整的多导睡眠图诊断协议用于诊断阻塞性睡眠呼吸暂停。（弱）我们建议，当最初的多导睡眠图是阴性的，临床怀疑为阻塞性睡眠呼吸暂停综合征仍然存在，第二多导睡眠图可以考虑诊断阻塞性睡眠呼吸暂停综合征。（弱）
Introduction: This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults.Methods: The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations.Recommendations: The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. 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.Good Practice Statements:Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up.Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation.Recommendations:1. We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG)2. We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG)3. We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG)4. We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG)5. We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK)6. We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK)