Perspective:

The following are 10 points to remember about this guideline from the American College of Physicians (ACP):

1. Since obesity is a risk factor for obstructive sleep apnea (OSA), the ACP recommends that all overweight and obese patients diagnosed with OSA should be encouraged to lose weight.

2. Continuous positive airway pressure (CPAP) treatment is recommended as initial therapy for patients diagnosed with OSA.

3. Mandibular advancement devices (MAD) are recommended as an alternative therapy to CPAP treatment for patients who prefer MAD or for those with adverse effects associated with CPAP.

4. There are no data to determine which patients benefit most from specific OSA treatment strategies.

5. CPAP is the most extensively studied therapy in OSA patients with excessive daytime sleepiness. This treatment has been shown to improve sleepiness scores, reduce the number of apnea or arousal scores, and increase oxygen saturation.

6. Clinical effectiveness of CPAP on outcomes such as hypertension, cardiovascular events, and death is uncertain.

7. Current evidence for use of pharmacologic agents as primary strategy for OSA management is insufficient.

8. Current evidence evaluating surgical treatment for OSA is insufficient to show benefits, and thus, should not be used as initial treatment.

9. Several, but not all observational studies of CPAP in the general population with OSA report significant reductions in overall mortality rates associated with CPAP use.

10. However, the authors identified no randomized controlled trial evaluating the effect of CPAP on mortality.

Note: Clinical practice guidelines are “guides” only, and may not apply to all patients and clinical situations. Thus, they are not intended to override clinicians’ judgment.