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 Guidelines Advisory Panel reviews and prioritizes suggested topics for clinical practice guidelines to identify those most suited for further pursuit. The AASM Board of Directors approves topics for development, then invites experts in sleep and circadian science 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 4-week public comment period before it is approved by the AASM Board of Directors for publication.

Clinical Practice Guideline for the Management of REM Behavior Disorder

This clinical practice guideline will provide practice recommendations for the management of REM Sleep Behavior Disorders (RBD). This guideline will update and replace the existing best practice guide for the treatment of RBD.

Task Force Chair: Michael Howell, MD

Task Force Members:

  • Alon Y. Avidan, MD, MPH (Vice Chair)
  • Emmanuel During, MD
  • Nancy Foldvary-Schaefer, DO, MS
  • Roneil Malkani, MD
  • Stuart J. McCarter, MD
  • Joshua Roland, MD

BOD Liaison:
Kannan Ramar, MD, MBBS

GAP Liaison:
Shelley Zak, MD

Staff: Gerard Carandang, MS

Patient Populations:

  1. Idiopathic RBD
  2. Secondary RBD due to medical condition
  3. Drug-induced RBD

Interventions:

  1. Clonazepam
  2. Melatonin
  3. Dopaminergic medications (e.g., Pramipexole, L-DOPA)
  4. Acetylcholinesterase inhibitors (e.g., Donepezil, Rivastigmine)
  5. Benzodiazepine receptor agonists (e.g., Zopiclone, Zolpidem)
  6. Benzodiazepines (e.g., Temazepam, Triazolam, Alprazolam)
  7. Dietary/herbal supplements (e.g., Tryptophan, Valerian, Yi-Gan San)
  8. Desipramine
  9. Clozapine
  10. Antiepileptic Drugs (e.g., Carbamazepine, Levetiracetam)
  11. Cannabidiol
  12. Sodium oxybate
  13. Ramelteon
  14. Agomelatine
  15. Memantine
  16. Antihypertensive medications (e.g., Prazosin, Clonidine)
  17. Bupropion
  18. Plasma exchange, Intravenous immunoglobin (IVIG)
  19. Deep brain stimulation
  20. PAP therapy
  21. Drug discontinuation

Outcomes:

  • Frequency of significant bed partner sleep disruption
  • Frequency of dream enactment episodes with injury
  • Frequency of dream enactment episodes without injury
  • Frequency and/or intensity of unpleasant dreams and nightmares
  • Change in REM motor tone – tonic and/or phasic
  • Quality of life
  • Treatment-related worsening in sedation or cognitive impairment
  • Treatment-related worsening in gait stability
  • Treatment-related worsening in symptoms of depression or anxiety

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 Management of Sleep-Disordered Breathing in Inpatients

This clinical practice guideline will provide practice recommendations for the management of sleep-disordered breathing in inpatients.

Task Force Chair: Reena Mehra, MD, MS

Task Force Members:

  • Dennis Auckley, MD (Vice Chair)
  • Martha Billings, MD
  • Karin Johnson, MD
  • Rami Khayat, MD
  • Cinthya Pena Orbea, MD
  • Susheel Patil, MD, PhD
  • Ashima Sahni, MD
  • Sunil Sharma, MD

BOD and GAP Liaison:
Vishesh Kapur, MD, MPH

Staff: Gerard Carandang, MS

Patient Populations:

Adult patients at risk for sleep-disordered breathing (or with a pre-admission diagnosis of sleep apnea) admitted to the hospital.

Interventions:

  1. Sleep apnea screening vs no screening
  2. Inpatient evaluation vs outpatient evaluation
  3. Positive airway pressure/supplemental oxygen/alternative therapies vs no treatment
  4. Inpatient sleep consult service vs other providers
  5. Inpatient physiologic monitoring vs no monitoring
  6. Post-discharge management with sleep medicine vs no post-discharge management with sleep medicine

Outcomes:

  • Mortality
  • Length of hospitalization
  • Readmission
  • Positive airway pressure adherence
  • Incidence of sleep-disordered breathing-related comorbidities (e.g. hypertension, cardiovascular events)
  • Daytime sleepiness
  • Quality of life
  • Sleep-disordered breathing diagnosis
  • Stroke recovery
  • Prevention of escalation in level of care (e.g. intubation, RRT support)
  • Time to diagnosis
  • Time to treatment
  • Time to post-discharge follow-up
  • Sleep quality
  • Dyspnea

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 Restless Legs Syndrome and Periodic Limb Movement Disorder

This clinical practice guideline will provide recommendations for the treatment of restless legs syndrome and periodic limb movement disorder in adults and pediatric patients. This guideline will update and replace the existing practice parameters.

Task Force Chair: Arthur S. Walters, MD

Task Force Members: 

  • John W. Winkelman, MD, PhD (Vice Chair)
  • Lourdes M. Del Rosso, MD
  • Denise Sharon, MD, PhD
  • Matthew Scharf, MD PhD
  • J. Andrew Berkowski, MD
  • Brian Koo, MD

BOD Liason: Anita Shelgikar, MD, MHPE

Staff: Christopher Harrod, MS

Patient Populations:

  1. Adult patients with Idiopathic/primary RLS
  2. Adult patients with RLS secondary to medical conditions
  3. Adult patients with Refractory RLS
  4. Adult patients with PLMD
  5. Pediatric patients with idiopathic RLS
  6. Pediatric patients with RLS secondary to medical conditions

 Interventions:

  1. Pharmacological management (dopamine agonists, dopaminergic agents, anticonvulsants, opioids, adrenergic agonists, hypnotics, other medications)
  2. Surgical management (subthalamic deep brain stimulation, for secondary RLS-hemodialysis, nerve decompression surgery, endovenous laser ablation)
  3. Non-pharmacological management (avoidance of caffeine, alcohol, nicotine; sleep hygiene; supplementation with one of several minerals or vitamins; valerian root extract; acupuncture; physical treatment methods)

Outcomes:

  1. Disease severity; including augmentation rate
  2. Quality of life
  3. Sleep quality
  4. Sleep efficiency
  5. Sleep latency
  6. Wake after sleep onset (WASO)
  7. Excessive daytime sleepiness
  8. Loss of work/school productivity
  9. Periodic Limb Movement frequency
  10. Depression/anxiety/mood disturbance
  11. Resolution of ADHD symptoms (in peds population)
  12. Adverse effect- related drop/discontinuation/ withdrawal from study
  13. Fatigue
  14. Poor work/school performance/attendance

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 Extrinsic Circadian Rhythm Sleep-Wake Disorders

This clinical practice guideline will provide recommendations for the treatment of extrinsic circadian rhythm sleep-wake disorders in adults and children. This guideline will update and replace the existing practice parameters.

Task Force Chair: Kenneth Wright, PhD

Task Force Members: 

  • Sabra Abbott, MD, PhD (Vice Chair)
  • Liza H Ashbrook, MD
  • Christopher Drake, PhD
  • Erin Flynn-Evans, PhD
  • Catherine McCall, MD

BOD and GAP Liason: Lynn Marie Trotti, MD, Msc

Staff: Uzma Kazmi, MPH

Patient Populations:

Adults with shift work disorder or jet lag disorder

Interventions:

  1. Planned sleep schedules/naps
  2. Timed light and or dark exposure
  3. Timed melatonin/melatonin agonist administration or other chronobiotic administration
  4. Sleep promoting medications (e.g., benzodiazepines, benzodiazepine receptor agonists) or substances
  5. Stimulant medications/ wake promoting medications or substances
  6. Caffeine
  7. Timed physical activity/exercise
  8. Diet and meal timing
  9. Combination treatments, CBT-I or sleep hygiene
  10. Planned work schedule

Outcomes:

  • Excessive sleepiness/alertness
  • Total sleep time
  • Sleep quality
  • Circadian alignment
  • Quality of life
  • Mental health
  • Cognitive performance/ work performance
  • Accident risk
  • Sleep efficiency
  • GI symptoms

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