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.
Highlights
The clinical questions (CQs) structure of this guideline is divided into Background Questions (BQs) and Foreground Questions (FQs), with the strength of recommendation added to FQ
We propose that patients with mild cases, along with those who have difficulty with standard treatment such as continuous positive airway pressure (CPAP) treatment, should be instructed regarding their sleeping position, upon confirming that apnea can be reduced in the lateral position. [Strength of recommendation: 2 (Consensus rate: 100%)] [Evidence level: D]
While there is no consistent evidence that weight loss in obstructive sleep apnea (OSA) patients improves risk factors for cardiovascular disease such as hypertension, diabetes, and dyslipidemia [24, 94, 100], most guidelines recommend that obese patients maintain an appropriate weight by correcting lifestyle habits [19, 101, 102]
Summary
Sleep and Biological Rhythms 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 Sleep apnea syndrome (SAS) · Guideline · Clinical question (CQ) · Continuous positive airway pressure (CPAP). History of medical care for sleep apnea and background of the publication of these guidelines
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