International Consensus Statement on Obstructive Sleep Apnea

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.

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References

Meccariello G, Cammaroto G, Montevecchi F, Hoff P, Spector M, Negm H . Transoral robotic surgery for the management of obstructive sleep apnea: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2016; 274(2):647-653. DOI: 10.1007/s00405-016-4113-3. View

Ayappa I, Norman R, Seelall V, Rapoport D . Validation of a self-applied unattended monitor for sleep disordered breathing. J Clin Sleep Med. 2008; 4(1):26-37. PMC: 2276822. View

Zhou J, Xia S, Li T, Liu R . Association between obstructive sleep apnea syndrome and nocturia: a meta-analysis. Sleep Breath. 2020; 24(4):1293-1298. DOI: 10.1007/s11325-019-01981-6. View

Gay P, Weaver T, Loube D, Iber C . Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults. Sleep. 2006; 29(3):381-401. DOI: 10.1093/sleep/29.3.381. View

Harvold E, Tomer B, Vargervik K, CHIERICI G . Primate experiments on oral respiration. Am J Orthod. 1981; 79(4):359-72. DOI: 10.1016/0002-9416(81)90379-1. View

Stenlof K, Grunstein R, Hedner J, Sjostrom L . Energy expenditure in obstructive sleep apnea: effects of treatment with continuous positive airway pressure. Am J Physiol. 1996; 271(6 Pt 1):E1036-43. DOI: 10.1152/ajpendo.1996.271.6.E1036. View

Rizzatti F, Mazzotti D, Mindel J, Maislin G, Keenan B, Bittencourt L . Defining Extreme Phenotypes of OSA Across International Sleep Centers. Chest. 2020; 158(3):1187-1197. PMC: 7478234. DOI: 10.1016/j.chest.2020.03.055. View

Bakker J, Tavakkoli A, Rueschman M, Wang W, Andrews R, Malhotra A . Gastric Banding Surgery versus Continuous Positive Airway Pressure for Obstructive Sleep Apnea: A Randomized Controlled Trial. Am J Respir Crit Care Med. 2017; 197(8):1080-1083. PMC: 5909166. DOI: 10.1164/rccm.201708-1637LE. View

Benoist L, de Ruiter M, de Lange J, de Vries N . A randomized, controlled trial of positional therapy versus oral appliance therapy for position-dependent sleep apnea. Sleep Med. 2017; 34:109-117. DOI: 10.1016/j.sleep.2017.01.024. View

10.

DApuzzo M, Browne J . Obstructive sleep apnea as a risk factor for postoperative complications after revision joint arthroplasty. J Arthroplasty. 2012; 27(8 Suppl):95-8. DOI: 10.1016/j.arth.2012.03.025. View

11.

Keenan S, Burt H, Ryan C, Fleetham J . Long-term survival of patients with obstructive sleep apnea treated by uvulopalatopharyngoplasty or nasal CPAP. Chest. 1994; 105(1):155-9. DOI: 10.1378/chest.105.1.155. View

12.

Walker R, Levine H, Hopp M, Greene D, Pang K . Palatal implants: a new approach for the treatment of obstructive sleep apnea. Otolaryngol Head Neck Surg. 2006; 135(4):549-54. DOI: 10.1016/j.otohns.2006.02.020. View

13.

Malhotra A, Fogel R, Edwards J, Shea S, White D . Local mechanisms drive genioglossus activation in obstructive sleep apnea. Am J Respir Crit Care Med. 2000; 161(5):1746-9. DOI: 10.1164/ajrccm.161.5.9907109. View

14.

Genta P, Schorr F, Eckert D, Gebrim E, Kayamori F, Moriya H . Upper airway collapsibility is associated with obesity and hyoid position. Sleep. 2014; 37(10):1673-8. PMC: 4173923. DOI: 10.5665/sleep.4078. View

15.

Horstmann S, Hess C, Bassetti C, Gugger M, Mathis J . Sleepiness-related accidents in sleep apnea patients. Sleep. 2000; 23(3):383-9. View

16.

Ainslie P, Lucas S, Burgess K . Breathing and sleep at high altitude. Respir Physiol Neurobiol. 2013; 188(3):233-56. DOI: 10.1016/j.resp.2013.05.020. View

17.

Cho S, Jeon J, Jang K, Kim S, Kim K, Ryu S . Gender-specific cephalometric features related to obesity in sleep apnea patients: trilogy of soft palate-mandible-hyoid bone. Maxillofac Plast Reconstr Surg. 2019; 41(1):58. PMC: 6904695. DOI: 10.1186/s40902-019-0242-0. View

18.

Martinez-Garcia M, Chiner E, Hernandez L, Cortes J, Catalan P, Ponce S . Obstructive sleep apnoea in the elderly: role of continuous positive airway pressure treatment. Eur Respir J. 2015; 46(1):142-51. DOI: 10.1183/09031936.00064214. View

19.

Friedman M, Ibrahim H, Bass L . Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg. 2002; 127(1):13-21. DOI: 10.1067/mhn.2002.126477. View

20.

de Vries C, de Raaff C, Ruys A, de Vries N, Hilgevoord A, van Wagensveld B . Validity of a simple sleep monitor for diagnosing OSA in bariatric surgery patients. Surg Obes Relat Dis. 2018; 14(7):1020-1025. DOI: 10.1016/j.soard.2018.02.019. View