Il ruolo delle competenze nella gestione del paziente OSA. Position paper dell’Associazione Italiana Pneumologi Ospedalieri – Italian Thoracic Society (AIPO-ITS).

The epidemiological impact and clinical consequences of obstructive sleep apnea have focused the attention of the sleep-dealing scientific community on this disorder. This document aims to emphasize the centrality of the physician with specific know-how, nurses and technicians during the diagnostic pathway, treatment and patient’s follow-up. The diagnostic pathway through cardio-respiratory monitoring or polysomnography during sleep must be customized and prescribed by an experienced physician in order to obtain a correct diagnosis, a personalized treatment and follow-up that allows to maintain an adequate adherence to the treatment over time. OSA is recognized as a complex and heterogeneous pathology and a diagnosis simply based on an AHI appears very reductive. There is a need to take into account at the same time the clinical-anamnestic aspect, the anatomical and the functional aspect to characterize the patient. A careful analysis of a polysomnographic exam or cardiorespiratory monitoring is able to provide pathophysiological information in order to obtain indices and patterns useful for an adequate patient treatment. OSA has multifactorial pathogenetic mechanism and this may explain why alternative treatments to CPAP have given different results to date, probably for inadequate patients characterization. Once it has been decided to treat the patient with CPAP, the pressure must be obtained by unloading the data from the card, interpreting the track when available, and not only by an automatic interpretation of the 90°-95° percentile of the pressure. Follow-up is an essential component in the management of the patient suffering from OSA as it allows to verify the appropriate adherence to treatment. [ABSTRACT FROM AUTHOR]