AASM releases new central sleep apnea guidelines

DARIEN, Ill. – A new clinical practice guideline developed by a task force of the American Academy of Sleep Medicine provides updated recommendations for the treatment of central sleep apnea. The guideline, published in Journal of Clinical Sleep Medicine, updates AASM’s previous practice parameters published in 2012 and 2016. Among other significant updates, it incorporates evidence from recent studies of adaptive servo ventilation and addresses new developments, including the introduction of transvenous phrenic nerve stimulation as a novel therapy. “Central sleep apnea is a complex form of sleep-disordered breathing that requires individualized, patient-centered care,” said lead author Dr. M. Safwan Badr, chair of the AASM task force and chair of the department of internal medicine at Wayne State University School of Medicine in Detroit. “It is essential for the treating clinician to prioritize improvements in quality of life and functional outcomes rather than focusing exclusively on the elimination of disordered breathing events.” The guidelines make nine clinical recommendations designated as “conditional,” meaning that they reflect a lower degree of certainty and require the clinician to use clinical judgment while considering the patient’s values and preferences to determine the best course of action. These recommendations support six treatment options for specific etiologies of central sleep apnea: continuous positive airway pressure, bilevel positive airway pressure with a backup rate, adaptive servo ventilation, low-flow oxygen, oral acetazolamide, and transvenous phrenic nerve stimulation. The guideline states that clinicians must consider the underlying condition contributing to breathing instability when selecting and optimizing therapy for central sleep apnea. This guideline was endorsed by the Alliance of Sleep Apnea Partners, American Association for Respiratory Care, American Association of Sleep Technologists, Australasian Sleep Association, European Respiratory Society, European Sleep Research Society, Heart Failure Society of America, Society of Anesthesia and Sleep Medicine, and the Society of Behavioral Sleep Medicine.