Introduction:

This guideline establishes clinical practice recommendations for referring adults with obstructive sleep apnea (OSA) for surgical consultation.

Methods:

The American Academy of Sleep Medicine (AASM) commissioned a task force of experts in sleep medicine, otolaryngology, and bariatric surgery to develop recommendations and assign strengths based on a systematic review of the literature and an assessment of the evidence using the GRADE process. The task force evaluated the relevant literature and the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations that support the recommendations. The AASM Board of Directors approved the final recommendations.

Recommendations:

The following recommendations are intended as a guide for clinicians who treat adults with OSA. Each recommendations statement is assigned a strength (“Strong” or “Conditional”). A “Strong” recommendation (i.e., “We recommend…”) is one that clinicians should follow under most circumstances. A “Conditional” recommendation is one that requires that the clinician use clinical knowledge and experience, and strongly consider the patient’s values and preferences to determine the best course of action.

1. We recommend that clinicians discuss referral to a sleep surgeon with adults with OSA and BMI<40 who are intolerant or unaccepting of PAP as part of a patient-oriented discussion of alternative treatment options. (STRONG)

2. We recommend that clinicians discuss referral to a bariatric surgeon with adults with OSA and obesity (class II/III, BMI ≥35) who are intolerant or unaccepting of PAP as part of a patient-oriented discussion of alternative treatment options. (STRONG)

3. We suggest that clinicians discuss referral to a sleep surgeon with adults with OSA, BMI<40, and persistent inadequate PAP adherence due to pressure-related side effects as part of a patient-oriented discussion of adjunctive or alternative treatment options. (CONDITIONAL)

4. We suggest clinicians recommend PAP as initial therapy for adults with OSA and a major upper airway anatomic abnormality prior to consideration of referral for upper airway surgery. (CONDITIONAL)

中文翻译：

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将阻塞性睡眠呼吸暂停成人转诊至外科会诊：美国睡眠医学会临床实践指南

介绍：

本指南为转诊阻塞性睡眠呼吸暂停 (OSA) 的成人进行外科会诊建立了临床实践建议。

方法：

美国睡眠医学会 (AASM) 委托一个由睡眠医学、耳鼻喉科和减肥手术专家组成的工作组，根据对文献的系统回顾和使用 GRADE 过程对证据的评估，制定建议并分配优势。工作组评估了相关文献和证据质量、利弊权衡、患者价值观和偏好以及支持建议的资源使用考虑因素。AASM 董事会批准了最终建议。

建议：

以下建议旨在作为治疗成人 OSA 的临床医生的指南。每个建议陈述都被分配了一个强度（“强”或“有条件”）。“强烈”推荐（即“我们推荐……”）是临床医生在大多数情况下应遵循的推荐。“有条件的”建议要求临床医生使用临床知识和经验，并强烈考虑患者的价值观和偏好，以确定最佳行动方案。

1. 作为以患者为导向的替代治疗方案讨论的一部分，我们建议临床医生与不耐受或不接受 PAP 的 OSA 和 BMI<40 的成年人讨论转诊至睡眠外科医生的问题。（强的）

2. 我们建议临床医生将不耐受或不接受 PAP 的 OSA 和肥胖成人（II/III 级，BMI ≥35）转诊给减肥外科医生，作为以患者为导向的替代治疗方案讨论的一部分。（强的）

3. 作为以患者为导向的辅助或替代治疗方案讨论的一部分，我们建议临床医生讨论将 OSA、BMI < 40 和由于压力相关副作用导致 PAP 依从性持续不足的成人转诊给睡眠外科医生。（有条件）

4. 我们建议临床医生推荐 PAP 作为成人 OSA 和主要上呼吸道解剖异常的初始治疗，然后再考虑转诊上呼吸道手术。（有条件）