Clinical Practice Guidelines, as defined by the National Academy of Medicine (formerly Institutes of Medicine) are “statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options.” AASM CPGs are targeted at clinicians, and provide recommendations for the evaluation, diagnosis, treatment and follow-up of patients with sleep disorders.
As outlined on the Guideline Development Process page, these guidelines are developed by a task force of experts who perform a systematic review of all published evidence on the topic. The evidence is then assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Evidence-based clinical practice recommendations are developed to provide overall diagnostic or treatment strategies for patients, taking into account the quality of evidence, balance of benefits versus harms, patient values and preferences and resource use. A draft of the guideline is made available for a 4-week public comment period before it is approved by the AASM Board of Directors for publication. All papers are reviewed at least every 5 years and updated as necessary. A list of current projects can be found on the Guidelines in Development page.
Clinical Guidance Statements, formerly called position papers, provide guidance on the use of diagnostic or treatment options for patients with sleep disorders when direct evidence is limited. Clinical Guidance Statements are developed based on both a qualitative review of the relevant literature and clinical expertise of the task force.
Previously, the AASM developed other document types to guide physicians in evaluating and managing patients with sleep disorders, such as practice parameters (recommendations based on an accompanying systematic review of the evidence), clinical guidelines (recommendations based on a review of the evidence, when available, or expert consensus) and best practice guides (recommendations based largely on expert consensus). Several of these are currently still active and will be updated as new evidence becomes available.
Position statements provide a concise explanation of the AASM’s position on certain issues related to policy (e.g., public policy, practice policy). Position statements are based primarily on expert consensus, and are supported by selected references. Health Advisories provide a synopsis of an issue related to sleep, and include advice for patients/consumers. Visit the Advocacy section for a list of current position statements and health advisories.
Consensus Statements and Papers
AASM Consensus Statements and Consensus Papers are developed by a panel of experts using a modified RAND Appropriateness Method consensus process, when little direct evidence is available. Consensus Statements provide a concise explanation of the panel’s position on a narrow topic of interest. Consensus Papers provide a more complete accounting of consensus conference proceedings, the evidence that was reviewed and any key discussion points that led to the final consensus
Promoting high-quality care in sleep medicine has always been a focus of the AASM, which accredited the first sleep center in 1977 and began developing evidence-based practice standards about 25 years ago. Today more than 2,500 AASM accredited sleep disorders centers across the U.S. are providing exceptional care for people who suffer from a chronic sleep disease. In keeping with its mission of promoting high-quality care, the AASM has developed quality measures for assessment and management of common sleep disorders.
The AASM has also partnered with the Choosing Wisely® campaign, an initiative of the ABIM Foundation, which aims to promote conversations between clinicians and patients by helping identify evidence-based care that is truly necessary and free from harm. The AASM developed a list of five Choosing Wisely statements, to help reduce unnecessary testing or treatments for patients with suspected or diagnosed sleep disorders.
Note: Choosing Wisely recommendations should not be used to establish coverage decisions or exclusions. Rather, they are meant to spur conversation about what is appropriate and necessary treatment. As each patient situation is unique, providers and patients should use the recommendations as guidelines to determine an appropriate treatment plan together.