Consensus & evidence-based INOSA Guidelines 2014 (first edition).

Area of Science:

• Sleep Medicine
• Respiratory Medicine
• Public Health

Background:

• Obstructive sleep apnoea (OSA) and obstructive sleep apnoea syndrome (OSAS) are common forms of sleep-disordered breathing.
• There is a significant lack of awareness regarding OSA and its health implications among the general public and primary care physicians in India.
• This knowledge gap necessitates the development of specific guidelines for diagnosis and management within the Indian context.

Purpose of the Study:

• To introduce the INdian initiative on Obstructive sleep apnoea (INOSA) guidelines.
• To define OSA and OSAS based on established criteria.
• To provide recommendations for screening, diagnosis, and treatment of OSA in India.

Main Methods:

• Development of the INOSA guidelines under the Department of Health Research, Ministry of Health & Family Welfare, Government of India.
• Definition of OSA based on the frequency of obstructive respiratory events per hour of sleep, with or without symptoms or comorbidities.
• Definition of OSAS as OSA with daytime symptoms, primarily excessive sleepiness.
• Recommendations for comprehensive sleep evaluation for individuals with specific risk factors (snoring, daytime sleepiness, obesity, hypertension, etc.).
• Emphasis on educating medical examiners for safety-critical professions about OSA evaluation.
• Referral for sleep studies (polysomnography) for suspected OSA cases.
• Identification of Positive Airway Pressure (PAP) therapy as the primary treatment.
• Indications for oral appliances and surgical interventions for OSA management.

Main Results:

• OSA is defined by specific criteria related to respiratory events and associated symptoms or comorbidities.
• OSAS is characterized by OSA accompanied by excessive daytime sleepiness.
• Comprehensive sleep evaluation is recommended for high-risk individuals and those in safety-critical occupations.
• Supervised overnight polysomnography (PSG) is the gold standard for OSA diagnosis.
• PAP therapy is the primary treatment modality for OSA.
• Oral appliances and surgery are alternative or adjunctive treatment options for specific patient groups.

Conclusions:

• The INOSA guidelines provide a framework for improving the recognition and management of OSA in India.
• Early and accurate diagnosis through comprehensive sleep evaluation and PSG is crucial.
• A multi-modal treatment approach, including PAP therapy, oral appliances, and surgery, should be tailored to individual patient needs.