The December 2021 Journal of Clinical Sleep Medicine included two papers outlining the American Academy of Sleep Medicine (AASM) recommendations regarding surgical consultation for adults with obstructive sleep apnea (OSA). The first publication was an assessment of the literature, finding that:

  • Upper airway surgery was associated with meaningful improvements in OSA signs and symptoms
  • Upper airway surgery was associated with a reduction in CPAP pressures and increased CPAP adherence
  • Bariatric surgery was associated with meaningful improvements in OSA signs and symptoms in those with obesity

The second publication was the AASM clinical practice guideline regarding referral for surgical consultation that was based on this literature review:

  1. Referral to a sleep surgeon for adults with OSA and body mass index < 40 kg/m2 who are intolerant or unaccepting of CPAP as part of a patient-oriented discussion of alternative treatment options (STRONG RECOMMENDATION)
  2. Referral to a bariatric surgeon for adults with OSA and body mass index >35 kg/m2 who are intolerant or unaccepting of CPAP as part of a patient-oriented discussion of alternative treatment options  (STRONG RECOMMENDATION)
  3. Referral to a sleep surgeon for adults with OSA and body mass index < 40 kg/m2 who have persistent inadequate CPAP adherence due to pressure-related side effects as part of a patient-oriented discussion of adjunctive or alternative treatment options (CONDITIONAL RECOMMENDATION)

This guideline was the product of substantial effort and expertise, emerging after thorough discussions over at least a couple of years. I am delighted to say that the task force charged with performing this work was led by one of our former fellows, David Kent at Vanderbilt University, and included another former fellow, Katherine Green at the University of Colorado. They are both already leaders in sleep surgery, and this is one more way they are leading the field forward.

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