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Three key principles for implementing the 2025 AASM CSA guideline in clinical practice
M. Safwan Badr, MD, Wayne State University School of Medicine, Detroit, MI, outlines three key principles for implementing the AASM central sleep apnea (CSA) treatment guideline in clinical practice. Prof. Badr explains that clinicians should first manage the underlying condition, such as heart failure or opioid use, and then treat comorbidities such as obstructive sleep apnea (OSA). He explains comorbid OSA affects more than two-thirds of patients with CSA, making CPAP a common starting point for treatment. Finally, he emphasizes the importance of using patient-reported outcomes to guide ongoing management.This interview was recorded on a virtual conference call with VJNeurology.
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Transcript
Well, the first one, which we had this across the board, is a clinical, a good practice principle, which is you have to manage the underlying condition. So example, if you have a patient with heart failure, with reduced ejection fraction, you need to optimize heart failure management. Somebody who is on opioid medication, we have to evaluate the need for it, whether we can actually lower the dose...
Well, the first one, which we had this across the board, is a clinical, a good practice principle, which is you have to manage the underlying condition. So example, if you have a patient with heart failure, with reduced ejection fraction, you need to optimize heart failure management. Somebody who is on opioid medication, we have to evaluate the need for it, whether we can actually lower the dose. So that’s probably the first things that we need to do. Second, think of other comorbidities. For example, obstructive sleep apnea exists in so many patients and actually more than two thirds of patients with central sleep apnea apnea. It’s a very common comorbid condition. So then we have to make sure we treat it. We will do a patient no service if we treat the central apnea and leave the obstructive apnea untreated, which is probably why positive pressure modalities such as CPAP is usually a starting point in the therapy. Now, the guidelines don’t rank the treatments and don’t give you a sequence. But generally speaking, in practice, we tend to start with CPAP, which allows us to treat both obstructive sleep apnea and the central apnea. And the third thing is we treat a patient, not a polysomnographic findings. So it’s important to follow up with our patients and see what their patient-reported outcomes are, how they’re feeling, daytime sleepiness, fatigue, whatever other symptoms, and be guided for this for future management. These are probably the three key principles I would like to emphasize.
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