The American Academy of Sleep Medicine (AASM) released two new guidelines on central sleep apnea (CSA) and obstructive sleep apnea (OSA). The guidelines, Treatment of Central Sleep Apnea in Adults and Evaluation and Management of Obstructive Sleep Apnea in Adults Hospitalized for Medical Care, both released in late August, are the products of an AASM-commissioned task force that was created to generate recommendations based on the latest research.

Below, are summaries of the recommendations from each guideline along with links to the full-text versions of these new 2025 AASM guidelines on sleep apnea.

Treatment of Central Sleep Apnea in Adults

This guideline establishes clinical practice recommendations for treatment of CSA in adults.

  1. The AASM suggests using continuous positive airway pressure (CPAP) over no CPAP in adults with CSA due to the following etiologies: primary CSA, CSA due to heart failure, CSA due to medication or substance use, treatment-emergent CSA, and CSA due to a medical condition or disorder. 
  2. The AASM suggests using bilevel positive airway pressure (BPAP) with a backup rate over no BPAP with a backup rate in adults with CSA due to the following etiologies: primary CSA, CSA due to medication or substance use, treatment-emergent CSA, and CSA due to a medical condition or disorder. 
  3. The AASM suggests against the use of BPAP without a backup rate in adults with CSA due to the following etiologies: primary CSA, CSA due to heart failure, CSA due to medication or substance use, treatment-emergent CSA, and CSA due to a medical condition or disorder. 
  4. The AASM suggests using adaptive servo ventilation (ASV) over no ASV in adults with CSA due to the following etiologies: primary CSA, CSA due to heart failure, CSA due to medication or substance use, treatment-emergent CSA, and CSA due to a medical condition or disorder. 
  5. The AASM suggests using low-flow oxygen over no low-flow oxygen in adults with CSA due to heart failure. 
  6. The AASM suggests using low-flow oxygen over no low-flow oxygen in adults with CSA due to high altitude.
  7. The AASM suggests using oral acetazolamide over no acetazolamide in adults with CSA due to the following etiologies: primary CSA, CSA due to heart failure, CSA due to medication or substance use, treatment-emergent CSA, and CSA due to a medical condition or disorder. 
  8. The AASM suggests using oral acetazolamide over no acetazolamide in adults with CSA due to high altitude.
  9. The AASM suggests using transvenous phrenic nerve stimulation (TPNS) over no TPNS in adults with CSA due to the following etiologies: primary CSA and CSA due to heart failure.

Full Text

Evaluation and Management of Obstructive Sleep Apnea in Adults Hospitalized for Medical Care.

The purpose of this guideline is to establish clinical practice recommendations for the management of OSA in medically hospitalized adults.

  1. For medically hospitalized adults at increased risk for OSA, the AASM suggests in-hospital screening for OSA as part of an evaluation and management pathway that incorporates diagnosis and treatment with positive airway pressure rather than no in-hospital screening. 
  2. For medically hospitalized adults with an established diagnosis of moderate-to-severe OSA and not currently on treatment, the AASM suggests the use of inpatient treatment with positive airway pressure rather than no positive airway pressure.
  3. For medically hospitalized adults at increased risk for or with an established diagnosis of OSA, the AASM suggests that sleep medicine consultation be available as part of an evaluation and management pathway, rather than no sleep medicine consultation. 
  4. For medically hospitalized adults at increased risk for or with an established diagnosis of OSA, the AASM suggests a discharge management plan to ensure timely diagnosis and effective management of OSA, rather than no plan.

Full Text 

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