Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine clinical practice guideline

About the Guideline

• This guideline provides clinical practice recommendations for referring adults with obstructive sleep apnea (OSA) for surgical consultation.
• The American Academy of Sleep Medicine (AASM) created a task force of experts in the fields of sleep medicine, bariatric surgery, and otolaryngology to review the most recent literature, assess the evidence, and develop recommendations to guide clinicians in treating OSA.
• The recommendations were created using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.
• This guideline provides recommendations regarding when to refer patients with OSA for surgical intervention and which patients are to be categorized into one of the following situations:
  • Intolerant or unaccepting of positive airway pressure (PAP)
  • Persistent, inadequate PAP adherence due to pressure-related side effects
  • Obvious upper airway anatomic abnormalities potentially amenable to surgery as initial OSA treatment
• For the purposes of this guideline, “sleep surgeon” refers to an otolaryngologist, or oral and maxillofacial surgeon experienced in upper airway surgery related to OSA.

Key Clinical Considerations

Positive Airway Pressure

Potential Adverse Effects of Surgery

Surgery as a Rescue Therapy

Bariatric Surgery

Referral to Sleep Surgeon

PAP as Initial Therapy

Reference