Guidelines in Development 2018-10-03T14:12:42+00:00

Guidelines in Development

AASM Clinical Practice Guidelines provide physicians with recommendations for the evaluation, diagnosis, treatment and follow-up of patients with sleep disorders.

The AASM Board of Directors reviews suggested topics for clinical practice guidelines to identify those most suited for further pursuit. The Board prioritizes the topics, then invites experts in sleep research and sleep medicine to develop the guideline.

The task force performs a systematic review of all published evidence on the topic, and then assesses the evidence 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 will be made available for a 2-week public comment period before it is approved by the AASM Board of Directors for publication.

Clinical Practice Guideline for the Use of Actigraphy in the Assessment of Sleep and Sleep Disorders

(Expected publication: July 2018)

This clinical practice guideline will provide practice recommendations for the use of actigraphy in the assessment of sleep parameters and treatment response in patients with diagnosed or suspected sleep disorders. This guideline will update and replace the existing practice parameters.

Task Force Chair: Michael T. Smith, MD

Task Force Members:

  • Jennifer L. Martin, PhD
  • Christina McCrae, PhD
  • Joseph Cheung, MD, MS

BOD Liason: Kelly Carden, MD

Patient Populations:

  1. Suspected insomnia disorder
  2. Suspected circadian rhythm sleep-wake disorders
  3. Suspected sleep-related breathing disorder
  4. Suspected hypersomnia
  5. Suspected periodic limb movement disorder
  6. Adults with suspected sleep or circadian rhythm sleep-wake disorder and cognitive impairment, in institutional settings
  7. Pediatric populations with suspected sleep or circadian rhythm sleep-wake disorder
  8. Individuals at risk for insufficient sleep syndrome

Interventions:

  1. Actigraphy

Outcomes:

  1. Total sleep time
  2. Sleep latency
  3. Wake after sleep onset
  4. Sleep efficiency
  5. Diagnostic accuracy
  6. Periodic limb movement index
  7. Sleep onset
  8. Sleep off-set

The final recommendations will be based upon the available evidence, and must be approved by the AASM Board of Directors.

Clinical Practice Guideline for the Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure

(Expected publication: Winter/Spring 2018)

This clinical practice guideline will provide practice recommendations for the use of positive airway pressure therapy to treat obstructive sleep apnea in adults. This guideline will update and replace the existing practice parameters on the use of APAP, CPAP and BPAP.

Task Force Chair: Susheel P. Patil, MD, PhD

Task Force Members:

  • Indu A. Ayappa, PhD
  • Sean M. Caples, DO
  • R. John Kimoff, MD
  • Sanjay R. Patel, MD

BOD Liason: Raman Malhotra, MD

Patient Populations:
Obstructive Sleep Apnea

Interventions:

  1. Continuous Positive Airway Pressure
  2. Auto-titrating Continuous Positive Airway Pressure
  3. Bi-level Positive Airway Pressure
  4. Modified pressure profile PAP
  5. Humidified PAP
  6. Education, behavior modification, and troubleshooting

Outcomes:

  1. Sleepiness
  2. Adherence
  3. QOL
  4. Neurocognitive Function
  5. Side Effects
  6. Motor Vehicle Accidents
  7. AHI/RDI
  8. Blood Pressure Control
  9. Glucose Control
  10. Incident Hypertension
  11. Incident Cardiovascular Events
  12. Incident Diabetes Mellitus
  13. All-Cause Mortality

The final recommendations will be based upon the available evidence, and must be approved by the AASM Board of Directors.

Position Paper on the use of the Multiple Sleep Latency Test and Maintenance of Wakefulness Test

(Expected publication: Fall/Winter 2019)

This position paper will provide the AASM’s positions on the use of the Multiple Sleep Latency Test (MSLT) and Maintenance of Wakefulness Test (MWT) in the diagnosis of narcolepsy and other hypersomnias of central origin. This paper will update and replace the existing practice parameters.

Task Force Chair: Lois Krahn, MD

Task Force Members:

  • Donna Arand, PhD
  • Alon Y. Avidan, MD
  • Kenneth Casey, MD
  • David Davila, MD
  • William DeBassio, MD

BOD Liason: Raman Malhotra, MD

The final positions will be based upon the available evidence and clinical expertise of the task force, and must be approved by the AASM Board of Directors.

Clinical Practice Guideline for the use of Psychological and Behavioral Treatment of Insomnia

(Expected publication: Spring/Summer 2019)

This clinical practice guideline will provide practice recommendations for the use of psychological and behavioral treatments of insomnia in adult patients, with the goal of identifying specific treatment components and delivery methods that are most effective to improve patient outcomes. This guideline will update and replace the existing practice parameters.

Task Force Chair: Jack D. Edinger, PhD

Task Force Members:

  • J. Todd Arnedt, PhD
  • Suzanne Bertisch, MD
  • Colleen Carney, PhD
  • John J. Harrington, MD
  • Kenneth Lichstein, PhD
  • Michael Sateia, MD
  • Wendy Troxel, PhD
  • Eric Zhou, PhD

BOD Liaison: Jennifer Martin, PhD


Patient Populations:

  1. Insomnia
  2. Comorbid insomnia
  3. Elderly
  4. Veterans/Active duty

Interventions:

  1. Biofeedback
  2. Cognitive behavioral therapy-insomnia
  3. Intensive sleep retraining
  4. Mindfulness
  5. Relaxation therapy
    1. Abdominal breathing
    2. Imagery training
    3. Autogenic training
  6. Paradoxical intention treatment
  7. Sleep hygiene
  8. Sleep restriction
  9. Stimulus control

Delivery:

  1. In-person, one-on-one visit with a trained CBT-I specialist
  2. In-person, one-on-one visit with provider who is not a trained behavioral and psychological specialist
  3. Group behavioral and psychological
  4. Telephone
  5. Self-help book
  6. Internet-delivered
  7. Community-based Workshop
  8. Telemedicine

Outcomes:

  1. Sleep Quality
  2. Sleep Onset Latency
  3. Wake After Sleep Onset
  4. Total Awake Time
  5. Quality of Life
  6. Total Sleep Time
  7. Number of Awakenings
  8. Sleep Efficiency
  9. Cognitive Functioning Domains
  10. Daytime Fatigue Domains
  11. Nights Using Hypnotics

The final recommendations will be based upon the available evidence, and must be approved by the AASM Board of Directors.

Clinical Practice Guideline for the Treatment of Narcolepsy and Other Hypersomnias of Central Origin

(Expected publication: Fall 2019)

This clinical practice guideline will provide practice recommendations for the treatment of narcolepsy and other hypersomnias of central origin. This guideline will update and replace the existing practice parameters.

Task Force Chair: Kiran Maski, MD

Task Force Members: 

  • Nathaniel Watson, MD (Vice Chair)
  • R. Robert Auger, MD
  • Suresh Kotagal, MD
  • Todd J. Swick, MD
  • Lynn Marie Trotti, MD

BOD Liason: James Rowley, MD

Patient Populations:

  1. Hypersomnia due to medical disorder, or associated with a psychiatric disorder, or associated with a neurological disorder
  2. Idiopathic Hypersomnia
  3. Kleine-Levin Syndrome
  4. Narcolepsy Type 1 or 2

Interventions:

  1. Pharmacological therapy: Anticonvulsant (Carbamazepine, Phenytoin, Valporic acid), Antimanic Agent (Lithium Carbonate), Anti-Parkinson Agent (Amantadine), Benzodiazepine receptor agonists (Eszopiclone, Zaleplon, Zolpidem), Benzodiazepine receptor antagonist (Flumazenil), Benzodiazepines (Temazepam, Triazolam), Central Nervous System Depressant (Sodium oxybate), Central Nervous System Stimulant (Amphetamines and related preparations, Armodafinil, Caffeine, Mazindol, Modafinil), Dietary Supplement (L-carnitine), H3 receptor inverse agonist (Pitolisant), Macrolide (Clarithromycin), Monoamine oxidase inhibitors/B (Selegiline), Norepinephrine Reuptake Inhibitor (Atomoxetine), Selective serotonin reuptake inhibitors (Citalopram, Escitalopram, Fluoxetine, Paroxetine, Sertraline), Serotonin/Norepinephrine Reuptake Inhibitor (Venlafaxine), Skeletal Muscle Relaxant (R-baclofen/baclofen), Thyroid Product (Levothyroxine), Tricyclic antidepressants (Amitriptyline, Amoxapine, Clomipramine, Doxepin, Imipramine, Maprotiline, Nortriptyline, Trimipramine), Combination therapy
  2. Behavioral therapy: Exercise, Scheduled naps/sleep extension, Sleep hygiene, Supportive care, Trigger avoidance
  3. Immunotherapy: Plasmapheresis, Intravenous immunoglobulin, Steroids

Outcomes:

  1. Difficulty waking in the morning
  2. Excessive daytime sleepiness
  3. Quality of life
  4. Sleep Quality
  5. Cognitive performance
  6. Disease severity
  7. Excessive daytime sleepiness
  8. Fatigue
  9. Poor work/school performance/attendance
  10. Sleep inertia
  11. Mood
  12. Accidents/accident risk
  13. Cataplexy

The final recommendations will be based upon the available evidence, and must be approved by the AASM Board of Directors.

Clinical Practice Guideline for the Surgical Treatment of OSA in Adults

(Expected publication: Winter 2019)

This clinical practice guideline will provide recommendations regarding if and under what circumstances adult patients with OSA should be referred for surgical consultation. This guideline will update and replace the existing practice parameters.

Task Force Chair: Steve Park, MD

Task Force Members: 

  • Daniel Gottlieb, MD, MPH
  • David Kent, MD
  • Corrina Levine, MD MPH
  • Jeffery J. Stanley, MD

BOD Liason: R. Nisha Aurora, MD

Patient Populations:

  1. Adult OSA patients
    • Subgroups include: patients with large tonsils
  2. Adult OSA patients who are intolerant to PAP or fail PAP
    • Subgroups include: patients w/ nasal compromise getting nasal surgery, patients with large tonsils getting tonsillectomy
  3. Adult OSA patients with Class III obesity (BMI > 40kg/m2)

Interventions:

  1. Upper airway surgery as a salvage treatment
  2. Upper airway surgery as an adjunctive treatment to PAP
  3. Upper airway surgery as a first-line treatment
  4. Bariatric surgery

Outcomes:

  • Symptoms (sleepiness, snoring)
  • Quality of Life (sleep-related, nasal-related)
  • Motor Vehicle Accident Risk
  • Health (long-term mortality risk, blood pressure, BMI)
  • Sleep Apnea Test Outcomes (AHI)
  • Positive-Airway Pressure (use, acceptance, pressure, oral leak)
  • Serious Adverse Events (peri-operative death, permanent dysphagia impairing eating, disabling bariatric events).

The final recommendations will be based upon the available evidence, and must be approved by the AASM Board of Directors.