Referral of Adults with Obstructive Sleep Apnea for Surgical Consultation

Remarks: The recommendation to discuss referral is not required to result in referral and does not preclude patient consideration of other viable alternative treatment options (eg, mandibular advancement device, positional therapy, lifestyle changes). The strong recommendation to discuss surgical referral with patients with a BMI < 40 kg/m2 is not a recommendation against (and does not preclude) discussion of surgical referral with patients with a BMI ≥ 40 kg/m2 if the health care provider deems it an appropriate management discussion point. For patients within the BMI range of 35–40 kg/m2, discussion regarding a referral to both sleep and bariatric surgeons (as per Recommendation 2) to discuss management options is appropriate.

Remarks: The recommendation to discuss referral is not required to result in referral and does not preclude patient consideration of medical weight loss strategies or other viable alternative treatment options for OSA. For patients within the BMI range of 35–40 kg/m2, discussion regarding a referral to both sleep and bariatric surgeons (as per Recommendations 1 and 3) to discuss management options is appropriate. The strong recommendation to discuss surgical referral with patients with OSA, obesity, and PAP intolerance or unacceptance is not a recommendation against (and does not preclude) discussion of surgical referral with patients with OSA, obesity, and adequate PAP use if the health care provider deems it an appropriate management discussion point. Other organizations, such as the National Heart, Lung, and Blood Institute, recommend consideration of bariatric surgery for individuals suffering from obesity (class II/III, BMI ≥ 35 kg/m2) and OSA, regardless of PAP adherence status.