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AASM Recommendations for Treatment

The American Academy of Sleep Medicine (AASM) is a professional organization of clinicians involved with the diagnosis and treatment of sleep disorders.1 The AASM Standards of Practice Committee has made the following treatment recommendations for those who suffer from obstructive sleep apnea. These recommendations are based on literature review, expert opinion, and consensus.

Optimal Treatment
According to the AASM, optimal treatment for snoring and sleep apnea is as follows.

Problem Goal of Treatment
Primary snoring Reduce the snoring to a subjectively acceptable level. 2
Obstructive Sleep Apnea (OSA) Resolution of the clinical signs and symptoms of OSA and the normalization of the apnea-hypopnea index and oxyhemoglobin saturation.2

For Mild to Moderate Obstructive Sleep Apnea
The American Academy of Sleep Medicine recommends oral appliances as a primary or first line of treatment for mild to moderate obstructive sleep apnea. Patients should always be offered the choice of an oral appliance if they have mild to moderate OSA.

Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer OAs to Continuous Positive Airway Pressure (CPAP), or who do not respond to CPAP, are not appropriate candidates for CPAP, or who fail treatment attempts with CPAP or treatment with behavioral measures such as weight loss or sleep position change. 2

For Moderate to Severe Obstructive Sleep Apnea
The American Academy of Sleep Medicine recommends Continuous Positive Airway Pressure (CPAP) for the treatment of moderate to severe sleep apnea. If patients have tried and failed CPAP, they should be offered treatment with an oral appliance. 

CPAP is indicated for the treatment of moderate to severe OSA.3

Patients with severe OSA should have an initial trial of nasal CPAP [prior to trying oral appliances].2

In some cases, surgery may be an appropriate treatment option. There are only three surgical procedures recommended by the AASM. These are surgery to remove the tonsils and adenoids, craniofacial surgery that involves breaking the upper and lower jaws to create a larger airway, and a tracheostomy – a surgical procedure that creates a new airway through a hole in the neck.

Upper airway surgery (including tonsillectomy and adenoidectomy, craniofacial operations and tracheostomy) may [be performed on] patients for whom these operations are predicted to be highly effective in treating sleep apnea.2

References:

  1. American Academy of Sleep Medicine website http://www.aasmnet.org
  2. Kushida CA; Morgenthaler TI; Littner MR et al. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: An Update for 2005. SLEEP 2006;29(2): 240-243.
  3. Kushida CA; Littner MR; Hirshkowitz M et al. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. SLEEP 2006;29(3):375-380.
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