International Journal of Head and Neck Surgery
Volume 10 | Issue 4 | Year 2019

American Academy of Sleep Medicine Guidelines, 2018

Anand Singh1, Harsh Meshram2, Milk Srikanth3

1Department of Respiratory Medicine, London North West University Healthcare NHS Trust-Ealing Hospital, London, UK
2,3Department of Chest Medicine, Lilavati Hospital and Research Center, Mumbai, Maharashtra, India

Corresponding Author: Anand Singh, Department of Respiratory Medicine, London North West University Healthcare NHS Trust-Ealing Hospital, London, UK, Phone: +44 2089675000, e-mail: anand69_ace@hotmail.com

How to cite this article Singh A, Meshram H, Srikanth M. American Academy of Sleep Medicine Guidelines, 2018. Int J Head Neck Surg 2019;10(4):102–103.

Source of support: Nil

Conflict of interest: None


Quality of care should be improved by following the clinical guidelines across the world. Guidelines have potential benefits not only for patients but also for clinicians and healthcare system in formulating the health schemes. Clinicians with sound knowledge need to identify the specific barriers, beyond knowledge, that stand in the way of behavioral change. Recent American Academy of Sleep Medicine (AASM) guidelines 2018 have come up with new recommendations such as split night polysomnography (PSG), repeat PSG in strongly suspected individuals with initial negative PSG and more to improve the specificity of diagnosis.

Keywords: AASM guidelines 2018, Clinical guidelines, Quality of care.





This provides a means of assessing sleep architecture and sleep duration in individuals. It can accurately diagnose circadian sleep disorders such as shift work disorder and delayed sleep phase syndrome. It is not reliable to diagnose OSA. In pediatric population/geriatric population when PSG is unavailable/technically difficult, actigraphy can be an useful adjunct.


These tests are indicated for individuals suspected to have narcolepsy/insomnia/circadian sleep disorders. These tests do not correlate with accident risk in real world and that clinical wisdom is more consistent to judge this (N).


PAP Therapy


This is the first-line treatment for moderate and severe OSA. It is an option for mild OSA (apnoea hypopnoea index %3C; 15); however, studies done have shown inconsistent results. The patients started on CPAP should be followed up in the clinic to monitor compliance and address issues related to CPAP such as humidification, mask/machine-related trouble. CPAP usage can be objectively measured as new devices have memory chips that store data.


Bi-level positive airway pressure devices are used to treat obesity hypoventilation syndrome and OSA associated with restrictive lung disease such as kyphoscoliosis.


APAP should not be used to diagnose OSA in titration studies or split night studies. Patients who have cardiovascular comorbidities contributing to desaturation should not use APAP. Individuals on fixed CPAP therapy settings as determined by APAP should be under clinical followup and should be considered for repeat polysomnography if symptoms do not resolve.

APAP devices can be used in self-adjusting mode for unsupervised treatment of OSA patients without cardiovascular/pulmonary comorbidities. APAP devices can be used to determine optimal pressure required for OSA patients without comorbidities; however, manual CPAP devices during polysomnography remain the gold standard.

Oromandibular Devices

They are the next best treatment option after CPAP. These devices should be prepared by qualified dentists. These patients should be followed up by sleep physicians to corroborate improvement clinically and on sleep study.

Medical Therapy of OSA

Weight loss via diet and exercise is essential for treatment of OSA and must be supplemented with definite treatment for OSA. (N) Topical nasal corticosteroids can reduce the AHI in individuals with concomitant rhinitis and OSA. It is now a useful adjunct therapy in OSA.410


CSA secondary to CHF (congestive heart failure)

Primary CSA

CSAS related to end-stage renal disease (N)


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