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Clinical Guidelines to Obstructive Sleep Apnea … · Clinical Guidelines to Obstructive Sleep Apnea Screening & Diagnosis STEP 1 STEP 3 STEP 2 STEP 4 1 Routine Health Maintenance

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Page 1: Clinical Guidelines to Obstructive Sleep Apnea … · Clinical Guidelines to Obstructive Sleep Apnea Screening & Diagnosis STEP 1 STEP 3 STEP 2 STEP 4 1 Routine Health Maintenance

Clinical Guidelines to Obstructive Sleep Apnea Screening & Diagnosis

ST

EP

1S

TE

P 3

ST

EP

2S

TE

P 4

1

Routine Health Maintenance Exam

Patient Complains of Symptoms

Sleep Disorder Symptoms (Check all that apply) Is the patient obese? Is the patient retrognathic? Does the patient have daytime sleepiness? Does the patient have hypertension? Does the patient have snore?

Sleep Evaluation (Check all that apply)

Does patient display OSA Symptoms?

Sleep StudyPolysomnography Full night Split night Home Sleep Testing (HST)Other sleep procedures

Results reviewed with sleep specialistTest results positive for OSA?

Discuss Treatment OptionsPatient Education

CPAP Behavioral Oral appliance Surgical Adjunctive Alternative Therapy

Evaluate for other sleep disorders or comorbidities

High Risk Screenings Obesity, Congestive Heart Failure, Atrial Fibrillation, Treatment Refractory Hypertension, Type 2 Diabetes, Nocturnal Dysrhythmias, Stroke, Pulmonary Hypertension, High Risk Driving Populations, Preoperative for Bariatric Surgery

yes

yes

yes

no

no

Screening & DiagnosisPrimary

Care

Screening & DiagnosisPrimary

Care

Primary Care

Primary Care

Screening & DiagnosisScreening & DiagnosisSleep

Specialist

SleepSpecialist

See Home Sleep Study Decision Tree

Treatment Compliance

Witnessed apneas Snoring Gasping/choking at night Unexplained excessive sleepiness Nonrefreshing sleep Total sleep amount Sleep fragmentation

Maintenance insomnia Nocturia Morning headaches Decreased concentration Memory loss Decreased libido Irritability

Page 2: Clinical Guidelines to Obstructive Sleep Apnea … · Clinical Guidelines to Obstructive Sleep Apnea Screening & Diagnosis STEP 1 STEP 3 STEP 2 STEP 4 1 Routine Health Maintenance

Expanding the reach of your sleep services today and tomorrow | 1.877.CLEVEMED | www.CleveMed.com

Patient presents for evaluation of suspected OSA

Does the patient have a high pretest probability of moderate to severe OSA? (Check all that apply)

Does patient have symptoms or signs of comorbid medical disorders?

(HST is not appropriate for patients with significant comorbid medical conditions including moderate to severe pulmonary disease, neuromuscular disease or congestive heart failure.)

Does patient have symptoms or signs of comorbid sleep disorders?

(HST is not appropriate in patients suspected of having other sleep disorders, including central sleep apnea, periodic limb movement disorder (PLMD), insomnia, parasomnias, circadian rhythm disorders or narcolepsy.)

Sleep StudyWhat type of test does patient prefer? What type of test is covered by insurance?

In-lab Sleep Study (PSG)

Home Sleep Study (HST)

Evaluate for other sleep disorders. Consider in-lab sleep study.

Home Sleep Study Decision Tree

yes

yes

yesno

no

See Step 4 in Clinical Guidelines to

Obstructive Sleep Apnea Screening & Diagnosis

no

“Clinical Guidelines for the Use of Unattended Portable Monitors in the Diagnosis of Obstructive Sleep Apnea in Adult Patients” by Portable Monitoring Task Force of the American Academy of Sleep Medicine, as seen in JCSM Journal of Clinical Sleep Medicine, Vol. 3, No. 7, 2007

“Clinical Guideline for the Evaluation, Management, and Long -term Care of Obstructive Sleep Apnea in Adult Patients” by Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine, as seen in JCSM Journal of Clinical Sleep Medicine, Vol. 5, No. 3, 2009

Obesity Congestive Heart Failure Atrial Fibrillation Treatment Refractory Hypertension Type 2 Diabetes

Nocturnal Dysrhythmias Stroke Pulmonary Hypertension High Risk Driving Populations Preoperative for Bariatric Surgery

2LMA-15-0004 Rev A DCO 843