[Guidelines for the diagnosis and treatment of obstructive sleep apnea in adults (2025)].

Abstract

Obstructive sleep apnea (OSA) is a highly prevalent sleep-related breathing disorder with a considerable healthcare burden. Previously, the 2011 guideline for adult obstructive sleep apnea was largely formulated on the basis of expert opinion and consensus, which played an important role in guiding clinical practice. With the growing body of evidence from high-quality clinical studies, however, guideline development models that rely primarily on expert consensus are no longer adequate to support contemporary clinical decision-making. To further standardize the screening, diagnosis, treatment, and long-term management of OSA in adults, the Sleep Disordered Breathing Assembly of the Chinese Thoracic Society has developed evidence-based clinical practice guidelines. The recommendations were formulated according to the best currently available evidence, following the Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) framework and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) statement. Based on an extensive preliminary investigation, the guideline addresses 18 key clinical questions and provides detailed, evidence-based recommendations, aiming to support clinical decision-making and to promote standardized diagnosis, treatment, and management of adults with OSA in China.The clinical questions and recommendations are listed below.Question 1: Which populations should be screened for OSA?Recommendation 1: Routine screening for OSA is not recommended in the general population without high-risk features (1, A). Screening is recommended for individuals at high risk for OSA who exhibit typical symptoms or physical signs, or who have relevant comorbidities. Screening is also recommended for perioperative patients (e.g., candidates for bariatric surgery or other high-risk procedures) (1, A). Screening may be considered for high-risk individuals without typical symptoms (2, B). Screening is also recommended for individuals whose OSA may increase the risk of driving or occupational accidents (1, A).High-risk populations for OSA include: (1) Individuals with typical OSA symptoms, such as habitual snoring, excessive daytime sleepiness, witnessed apneas, nocturnal gasping or choking, morning headaches, morning dry mouth, non-restorative sleep, nocturia, impaired attention, memory decline, and reduced sexual function; (2) Individuals with typical physical signs of OSA, including obesity, increased neck circumference, retrognathia or micrognathia, macroglossia, enlarged uvula and soft palate, and tonsillar hypertrophy; (3) Individuals with OSA-related complications or comorbidities, such as obesity, hypertension, type 2 diabetes mellitus, cardiovascular disease, metabolic syndrome, hypothyroidism, polycystic ovary syndrome, acromegaly, neuromuscular diseases, depression, and anxiety; (4) Specific populations, including middle-aged and older men, pregnant women, and postmenopausal women; (5) Individuals with a family history of OSA,