International Consensus Statement on Obstructive Sleep Apnea

• Type of Material: Article
• Authors: Jolie L. Chang, University of California San Francisco; Andrew N. Goldberg, University of California San Francisco; Jeremiah A. Alt, University of Utah; Mohammed Alzoubaidi, Northwestern University; Liza Ashbrook, University of California San Francisco; Jason L. Yu, Emory University
• Language: English
• Date: 2024-01-01
• Publisher: John Wiley and Sons
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 ARS‐AAOA, LLC.
• Final Published Version (URL): https://doi.org/10.1002/alr.23079
• Title of Journal or Parent Work: International Forum of Allergy & Rhinology
• Volume: 13
• Issue: 7
• Start Page: 1061
• End Page: 1482
• Keywords: surgical outcomes; sleep disordered breathing; screening; cerebrovascular disease; polysomnography; motor vehicle accidents; PAP adherence; neurocognitive function; outcomes; consensus; cardiovascular event; mortality; positive airway pressure; atrial fibrillation; home sleep apnea testing; treatment outcomes; evidence-based medicine; dementia; sleepiness; hypertension; uvulopalatopharyngoplasty; obstructive sleep apnea; sleep surgery; systematic review; perioperative management; hypoglossal nerve stimulation; sleep
• Subject - Topics: Sleep apnea syndromes; Sleep

Abstract

Background: Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). Methods: Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. Results: The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. Conclusion: This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.