Sleep Apnea Syndrome (SAS) Clinical Practice Guidelines 2020

Abstract

The prevalence of sleep-disordered breathing (SDB) is reportedly very high. Among SDBs, the incidence of obstructive sleep apnea (OSA) is higher than previously believed, with patients having moderate-to-severe OSA accounting for approximately 20% of adult males and 10% of postmenopausal women not only in Western countries but also in Eastern countries, including Japan. Since 1998, when health insurance coverage became available, the number of patients using continuous positive airway pressure (CPAP) therapy for sleep apnea has increased sharply, with the number of patients about to exceed 500,000 in Japan. Although the "Guidelines for Diagnosis and Treatment of Sleep Apnea Syndrome (SAS) in Adults" was published in 2005, a new guideline was prepared to indicate the standard medical care based on the latest trends, as supervised by and in cooperation with the Japanese Respiratory Society and the "Survey and Research on Refractory Respiratory Diseases and Pulmonary Hypertension" Group, of Ministry of Health, Labor and Welfare and other related academic societies, including the Japanese Society of Sleep Research, in addition to referring to the previous guidelines. Since sleep apnea is an interdisciplinary field covering many areas, this guideline was prepared including 36 clinical questions (CQs). In the English version, therapies and managements for SAS, which were written from CQ16 to 36, were shown. The Japanese version was published in July 2020 and permitted as well as published as one of the Medical Information Network Distribution Service (Minds) clinical practice guidelines in Japan in July 2021.

Keywords: Clinical question (CQ); Continuous positive airway pressure (CPAP); Guideline; Sleep apnea syndrome (SAS).

Fig. 1

Actuals of the number of patients at-home respiratory management. Prepared by quoting materials from Ministry of Health, Labor and Welfare: Statistics by Social Medical Practice [1]. *The number of registered medical facilities

Fig. 2

Algorithm for the diagnosis and treatment of sleep apnea, considering medical insurance treatment. *AHI includes PSG AHI, simple monitor respiratory event index (traditional Japanese respiratory disturbance index), and oxygen desaturation index. Dotted line: examination or treatment options that may be considered. (The Japanese Circulation Society, Guidelines for Diagnosis and Treatment of Cardiovascular Diseases (2008–2009 Joint Research Group Report) Guidelines for the Diagnosis and Treatment of Sleep Respiratory Disorders in the Cardiovascular Area, which was prepared by referring to < http://www.j-circ.or.jp/guideline/pdf/JCS2010. momomura.h.pdf > [4])

Fig. 3

Treatment strategy for Cheyne–Stokes Breathing (CSB) associated with chronic heart failure. *≥ 15/h appears to be appropriate with regard to this AHI standard, but can be changed to ≥ 20/h taking into consideration the adaptive standard for CPAP medical insurance treatment. ^†Attention should be paid to patients with heart failure due to decreased left ventricular contractile function (left ventricular ejection fraction ≤ 45%), which are in a stable state with central-dominant sleep apnea (statements by The Japanese Circulation Society, and The Japanese Heart Failure Society). Joint Guideline by The Japanese Circulation Society and The Japanese Heart Failure Society, for Acute/Chronic Heart Failure Clinical Practice Guidelines (2017 revised edition). ^‡In Japan, ASV is used for severe congestion regardless of the presence or absence of sleep apnea, with ASV use for patients with heart failure approved. (Japanese Respiratory Society NPPV Guideline Preparation Committee (ed.): NPPV (Non-Invasive Positive Pressure Ventilation Therapy) Guideline, 2nd Edition, quoted and modified from p.129, 2015.)