Patient handout

Obstructive sleep apnea (adult chronic — AASM dx + PAP-first therapy ladder)

PRODUCTION

1. Your condition

This handout is for obstructive sleep apnea (adult chronic — aasm dx + pap-first therapy ladder). Your care team identified this based on: loud habitual snoring + witnessed apnea + daytime sleepiness (aasm 2017 dx cpg).

Other reasons your team may use this plan: non-restorative sleep, nocturia, morning headache, choking/gasping arousals (aasm 2017); resistant hypertension / atrial fibrillation / stroke — osa contributory cause; reciprocal screen (cardio.htn.resistant.v1, cardio.afib.core.v1); obesity / t2dm / metabolic syndrome — high pretest osa probability (senaratna pmid 27568340; surmount-osa pmid 38912654).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
CPAP (fixed) or auto-titrating APAP + behavioural/educational/telemonitoring adherence interventions	CPAP 4–20 cmH2O titrated (in-lab or APAP auto-set); humidified; mask-fit + desensitisation; compliance target ≥4 h/night on ≥70% of nights	nasal/oronasal mask	every sleep period	AASM 2019 PAP CPG (PMID 30736887) STRONG recommendation — CPAP/APAP first-line; reduces AHI, sleepiness (Epworth), improves QoL and lowers BP (SBP −2.5 / DBP −2.0 mmHg, +1 h/night → additional −1.5/−0.9 mmHg; Bratton JAMA 2015 PMID 26624827). HONESTY: SAVE (PMID 27571048) showed NO reduction in CV events in established CVD with non-sleepy OSA — value is symptom/QoL/BP, not CV mortality

Plan: OSA PAP-first therapy ladder (AASM 2019 PAP CPG) — chronic outpatient

3. When to call your provider

Contact your care team if any of the following happen:

Severe sleepiness + driving/occupational hazard (Epworth ≥16 or near-miss MVA) → expedite testing + treatment + driving counselling
Suspected OHS (awake hypercapnia, HCO3 ≥27 → ABG PaCO2 ≥45) → NIV/BiPAP pathway + sleep medicine
Suspected predominant CSA in HFrEF (heart pumping strength (LVEF) ≤45%) → cardiology + sleep medicine; do NOT prescribe ASV (SERVE-HF PMID 26323938)
Decompensated cor pulmonale / refractory hypoxemia → escalate care
CPAP-intolerant despite ≥3-month structured adherence programme → sleep-medicine referral for alternative ladder

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

AHI ≥30 (severe) with excessive sleepiness (Epworth ≥16) AND/OR established CV disease/AF/resistant-HTN AND/OR safety-sensitive occupation (commercial driver) — high-priority treat-and-document
Awake hypercapnia — serum HCO3 ≥27 prompting ABG, PaCO2 ≥45 mmHg with obesity (BMI ≥30) and sleep-disordered breathing = obesity-hypoventilation syndrome (OHS), NOT plain OSA
HFrEF (heart pumping strength (LVEF) ≤45%) with predominant central sleep apnea / Cheyne-Stokes respiration — adaptive servo-ventilation (ASV) is CONTRAINDICATED (HARM signal)(life-threatening)

5. Follow-up

Annual review; re-titration if ≥10% weight change or pregnancy; reinforce adherence (early adherence predicts long-term — adherence ~50% at 1 yr); driving-safety re-attestation for CDL; comorbidity (HTN/AF/T2DM/stroke) co-management; pregnancy re-evaluation post-partum

6. Sources

Guideline: AASM 2017 Diagnostic Testing for Adult OSA CPG (Kapur) + AASM 2019 PAP Treatment of Adult OSA CPG (Patil) + AASM 2021 surgical-referral CPG (Kent) + AASM 2025 hospitalized-OSA CPG (Mehra) + AASM Manual respiratory-event scoring (Berry); ICSD-3-TR (AASM 2023) diagnostic classification