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European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea

Winfried Randerath, Johan Verbraecken, Christel A.L. de Raaff, Jan Hedner, Simon Herkenrath, Winfried Hohenhorst, Tina Jakob, Oreste Marrone, Marie Marklund, Walter T. McNicholas, Rebecca L. Morgan, Jean-Louis Pepin, Sofia Schiza, Nicole Skoetz, Dan Smyth, Jörg Steier, Thomy Tonia, Wojciech Trzepizur, Piet-Heijn van Mechelen, Peter Wijkstra
European Respiratory Review 2021 30: 210200; DOI: 10.1183/16000617.0200-2021
Winfried Randerath
1Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
20Co-shared first authorship
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  • ORCID record for Winfried Randerath
  • For correspondence: randerath@klinik-bethanien.de
Johan Verbraecken
2Antwerp University Hospital and University of Antwerp, Edegem (Antwerp), Belgium
20Co-shared first authorship
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Christel A.L. de Raaff
3Amsterdam UMC, Dept of Surgery, Amsterdam, The Netherlands
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Jan Hedner
4Dept of Sleep Medicine, Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Simon Herkenrath
1Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
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Winfried Hohenhorst
5Alfried Krupp Hospital, Dept of Otolaryngology, Essen, Germany
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Tina Jakob
6Evidence-based Oncology, Dept I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Oreste Marrone
7National Research Council of Italy, Institute for Biomedical Research and Innovation, Palermo, Italy
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Marie Marklund
8Dept of Odontology, Faculty of Medicine, Umeå University, Umeå, Sweden
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Walter T. McNicholas
9School of Medicine, University College Dublin, Dublin, Ireland
10Dept of Respiratory and Sleep Medicine, St Vincent's Hospital Group, Dublin, Ireland
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  • ORCID record for Walter T. McNicholas
Rebecca L. Morgan
11Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Jean-Louis Pepin
12EFCR Sleep and Respiration Unit CHU Grenoble, Grenoble, France
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Sofia Schiza
13Sleep Disorders Unit, Dept of Respiratory Medicine, Medical School, University of Crete, Greece
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Nicole Skoetz
6Evidence-based Oncology, Dept I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Dan Smyth
14European Lung Foundation, Sheffield, UK
15Sleep Disorder Support Foundation, Dublin, Ireland
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Jörg Steier
16Lane Fox Unit and Sleep Disorders Centre at Guy's & St Thomas’ NHS Foundation Trust, Centre for Human & Applied Physiological Sciences, King's College London, London, UK
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Thomy Tonia
17Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Wojciech Trzepizur
18Dept of Respiratory and Sleep Medicine, Angers University hospital, Angers, France
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Piet-Heijn van Mechelen
14European Lung Foundation, Sheffield, UK
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Peter Wijkstra
19Dept of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Tables

  • Supplementary Materials
  • TABLE 1

    Patient, intervention, comparison, outcome (PICO) questions

    QuestionPopulationInterventionComparisonOutcomeRecommendation
    PICO 1In adult obese patients with OSA, should laparoscopic RYGB surgery or weight-reducing diet be used?Obese patients with OSALaparoscopic RYGB surgeryWeight-reducing dietAHI; sleep efficiency; health-related quality of life; sleepiness; hypertension; compliance; adverse eventsConditional recommendation for the intervention, very low quality of evidence
    PICO 2Should a custom-made dual-block mandibular advancement device or CPAP be used for adult patients with OSA?Adult patients with OSACustom-made dual-block mandibular advancement deviceCPAPAHI; sleep efficiency; oxygen desaturation; sleepiness; physical functioning; arterial hypertension; compliance; adverse eventsConditional recommendation against the intervention, very low quality of evidence
    PICO 3Should hypoglossal nerve stimulation during sleep or no treatment be used for adult patients with OSA?Adult patients with OSAHypoglossal nerve stimulationNo treatmentAHI; sleep efficiency; oxygen desaturation; sleepiness; physical functioning; arterial hypertension; compliance; adverse eventsConditional recommendation against the intervention, very low quality of evidence
    PICO 4aIn adult patients with OSA, should myofunctional therapy or no treatment be used?Adult patients with OSAMyofunctional therapyNo treatmentAHI; sleep efficiency; sleepiness; physical functioning; compliance; adverse eventsConditional recommendation for either the intervention or the comparison, low quality of evidence
    PICO 4bShould myofunctional therapy or CPAP be used for adult patients with OSA?Adult patients with OSAMyofunctional therapyCPAPAHI; sleep efficiency; sleepiness; physical functioning; compliance; adverse eventsConditional recommendation against the intervention, low quality of evidence
    PICO 5Should maxillo-mandibular osteotomy or CPAP be used for adult patients with OSA?Adult patients with OSAMaxillo-mandibular osteotomyCPAPAHI; sleepiness; satisfaction; adverse eventsConditional recommendation for either the intervention or the comparison, very low quality of evidence
    PICO 6Should carbonic anhydrase inhibitors (compared to placebo) be used for adult patients with OSA?Adult patients with OSACarbonic anhydrase inhibitorsPlaceboAHI; sleep efficiency; oxygen desaturation; sleepiness; arterial hypertension; compliance; adverse eventsConditional recommendation for the intervention, low quality of evidence
    PICO 7Should positional therapy or CPAP be used for adult patients with position-dependent OSA?Adult patients with position-dependent OSAPositional therapyCPAPAHI; sleep efficiency; oxygen desaturation; sleepiness; health-related quality of life; energy level scores; compliance; adverse eventsConditional recommendation for either the intervention or the comparison, very low certainty of evidence
    PICO 8Should positional therapy (intervention) or custom made dual-block mandibular advancement devices (control) be used for adult patients with position-dependent OSA?Adult patients with position-dependent OSAPositional therapyCustom-made dual-block mandibular advancement deviceAHI; sleep efficiency; oxygen desaturation; sleepiness; arterial hypertension; adherence; adverse events; quality of lifeConditional recommendation for either the intervention or the comparison, very low certainty of evidence

    OSA: obstructive sleep apnoea; RYGB: Roux-en-Y gastric bypass; AHI: apnoea–hypopnoea index; CPAP: continuous positive airway pressure.

    Supplementary Materials

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    • Supplementary Material

      Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

      Supplementary material ERR-0200-2021.SUPPLEMENT

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    European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea
    Winfried Randerath, Johan Verbraecken, Christel A.L. de Raaff, Jan Hedner, Simon Herkenrath, Winfried Hohenhorst, Tina Jakob, Oreste Marrone, Marie Marklund, Walter T. McNicholas, Rebecca L. Morgan, Jean-Louis Pepin, Sofia Schiza, Nicole Skoetz, Dan Smyth, Jörg Steier, Thomy Tonia, Wojciech Trzepizur, Piet-Heijn van Mechelen, Peter Wijkstra
    European Respiratory Review Dec 2021, 30 (162) 210200; DOI: 10.1183/16000617.0200-2021

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    European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea
    Winfried Randerath, Johan Verbraecken, Christel A.L. de Raaff, Jan Hedner, Simon Herkenrath, Winfried Hohenhorst, Tina Jakob, Oreste Marrone, Marie Marklund, Walter T. McNicholas, Rebecca L. Morgan, Jean-Louis Pepin, Sofia Schiza, Nicole Skoetz, Dan Smyth, Jörg Steier, Thomy Tonia, Wojciech Trzepizur, Piet-Heijn van Mechelen, Peter Wijkstra
    European Respiratory Review Dec 2021, 30 (162) 210200; DOI: 10.1183/16000617.0200-2021
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