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International Consensus Statement on Obstructive Sleep Apnea - PubMed

Review

. 2023 Jul;13(7):1061-1482.

doi: 10.1002/alr.23079. Epub 2023 Mar 30.

Andrew N Goldberg  1 , Jeremiah A Alt  2 , Alzoubaidi Mohammed  3 , Liza Ashbrook  1 , Dennis Auckley  4 , Indu Ayappa  5 , Hira Bakhtiar  6 , José E Barrera  7 , Bethany L Bartley  8 , Martha E Billings  9 , Maurits S Boon  10 , Pien Bosschieter  11 , Itzhak Braverman  12 , Kara Brodie  1 , Cristina Cabrera-Muffly  13 , Ray Caesar  14 , Michel B Cahali  15 , Yi Cai  1 , Michelle Cao  16 , Robson Capasso  16 , Sean M Caples  17 , Lana M Chahine  18 , Corissa P Chang  19 , Katherine W Chang  20 , Nilika Chaudhary  21 , Crystal S J Cheong  22 , Susmita Chowdhuri  23 , Peter A Cistulli  24 , David Claman  1 , Jacob Collen  25 , Kevin C Coughlin  26 , Jennifer Creamer  25 , Eric M Davis  27 , Kara L Dupuy-McCauley  17 , Megan L Durr  28 , Mohan Dutt  29 , Mazen El Ali  18 , Nabil M Elkassabany  27 , Lawrence J Epstein  8 , Justin A Fiala  3 , Neil Freedman  30 , Kirat Gill  16 , M Boyd Gillespie  26 , Lea Golisch  31 , Nalaka Gooneratne  19 , Daniel J Gottlieb  8 , Katherine K Green  32 , Arushi Gulati  1 , Indira Gurubhagavatula  19 , Nathan Hayward  33 , Paul T Hoff  29 , Oliver M G Hoffmann  31 , Steven J Holfinger  34 , Jennifer Hsia  35 , Colin Huntley  10 , Kevin C Huoh  36 , Phillip Huyett  8 , Sanjana Inala  5 , Stacey L Ishman  37 , Tarun K Jella  4 , Aesha M Jobanputra  38 , Andrew P Johnson  13 , Mithri R Junna  17 , Jenna T Kado  39 , Thomas M Kaffenberger  18 , Vishesh K Kapur  9 , Eric J Kezirian  40 , Meena Khan  34 , Douglas B Kirsch  41 , Alan Kominsky  42 , Meir Kryger  43 , Andrew D Krystal  1 , Clete A Kushida  16 , Thomas J Kuzniar  30 , Derek J Lam  44 , Christopher J Lettieri  25 , Diane C Lim  45 , Hsin-Ching Lin  46 , Stanley Y C Liu  16 , Stuart G MacKay  47 , Ulysses J Magalang  34 , Atul Malhotra  48 , Meghna P Mansukhani  17 , Joachim T Maurer  31 , Anna M May  4 , Ron B Mitchell  49 , Babak Mokhlesi  50 , Anna E Mullins  30 , Eman M Nada  51 , Sreelatha Naik  52 , Brandon Nokes  48 , Michael D Olson  17 , Allan I Pack  19 , Edward B Pang  53 , Kenny P Pang  54 , Susheel P Patil  4 , Eli Van de Perck  55 , Jay F Piccirillo  20 , Grace W Pien  56 , Amanda J Piper  57 , Andrea Plawecki  58 , Mark Quigg  27 , Madeline J L Ravesloot  59 , Susan Redline  60 , Brian W Rotenberg  61 , Armand Ryden  62 , Kathleen F Sarmiento  1 , Firas Sbeih  42 , Amy E Schell  32 , Christopher N Schmickl  48 , Helena M Schotland  5 , Richard J Schwab  19 , Jiyeon Seo  63 , Neomi Shah  5 , Anita Valanju Shelgikar  29 , Isaac Shochat  64 , Ryan J Soose  18 , Toby O Steele  65 , Erika Stephens  1 , Carl Stepnowsky  48 , Kingman P Strohl  4 , Kate Sutherland  57 , Maria V Suurna  66 , Erica Thaler  19 , Sritika Thapa  43 , Olivier M Vanderveken  55 , Nico de Vries  11 , Edward M Weaver  9 , Ian D Weir  43 , Lisa F Wolfe  3 , B Tucker Woodson  67 , Christine H J Won  43 , Josie Xu  68 , Pratyusha Yalamanchi  29 , Kathleen Yaremchuk  58 , Yerem Yeghiazarians  1 , Jason L Yu  69 , Michelle Zeidler  63 , Ilene M Rosen  19

Affiliations

Review

International Consensus Statement on Obstructive Sleep Apnea

Jolie L Chang et al. Int Forum Allergy Rhinol. 2023 Jul.

Abstract

Background: Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA).

Methods: Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus.

Results: The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated.

Conclusion: This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

Keywords: PAP adherence; atrial fibrillation; cardiovascular event; cerebrovascular disease; consensus; dementia; evidence-based medicine; home sleep apnea testing; hypertension; hypoglossal nerve stimulation; mortality; motor vehicle accidents; neurocognitive function; obstructive sleep apnea; outcomes; perioperative management; polysomnography; positive airway pressure; screening; sleep; sleep disordered breathing; sleep surgery; sleepiness; surgical outcomes; systematic review; treatment outcomes; uvulopalatopharyngoplasty.

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Figures

FIGURE IX.C.2
FIGURE IX.C.2

The VOTE classification

FIGURE IV.C.3
FIGURE IV.C.3

Common sagittal cephalometric findings associated with obstructive sleep apnea (OSA): (A) decreased cranial base length, (B) decreased maxillary length, (C) decreased mandibular length, (D) decreased posterior facial height, (E, F) increased anterior lower facial height and total facial height, (G) decreased cranial base angle, (H) decreased gonial angle (posterior rotation of mandible), (I) inferior and posterior displacement of the hyoid bone.

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