Management of Chronic Insomia Disorder and Obstructive Sleep Apnea (Insomia/OSA) (2019)

1. For patients who report sleep complaints, we suggest using the STOP questionnaire to stratify the risk of obstructive sleep apnea. (Weak for)

2. We suggest that providers assess for sleep disordered breathing in patients with a history of cardiovascular or cerebrovascular events, congestive heart, and chronic prescription opioid use. (Weak for)

3. Among patients with a high pretest probability for obstructive sleep apnea, we suggest a manually-scored type III home sleep apnea test (unattended portable monitor) using an event index (i.e., respiratory disturbance index, apnea-hypopnea index) ≥15 events per hour to establish the diagnosis of moderate to severe obstructive sleep apnea. (Weak for)

4. For patients with a high pretest probability for obstructive sleep apnea and a non-diagnostic home sleep apnea test (i.e., technically inadequate or apnea-hypopnea index <5), we recommend repeat (home sleep apnea testing or lab-based polysomnography) testing for obstructive sleep apnea. (Strong for)

5. For evaluating patients suspected of having insomnia disorder, we suggest using the Insomnia Severity Index or Athens Insomnia Scale as part of a comprehensive sleep assessment. (Weak for)

6. There is no available evidence to recommend for or against additional diagnostic testing for patients with chronic insomnia disorder who do not respond to cognitive behavioral therapy for insomnia (CBT-I) or pharmacotherapy. ()