HealthDay News – In a new practice guideline, published online February 18 in the Annals of Internal Medicine, recommendations are presented for the screening, evaluation, and treatment of obstructive sleep apnea (OSA) and chronic insomnia disorder in military personnel and veterans.

Vincent Mysliwiec, MD, from the University of Texas Health Science Center at San Antonio, and colleagues developed recommendations for individual needs and preferences of US Department of Veterans Affairs and US Department of Defense patients with chronic insomnia disorder and OSA.

The authors developed 3 one-page algorithms and advanced 41 recommendations. The key recommendations were summarized into the areas of diagnosis and assessment of chronic insomnia disorder and OSA, treatment and management of chronic insomnia disorder, and treatment and management of OSA. Patients with OSA should receive positive airway pressure (PAP) therapy for the entirety of their sleep periods; PAP therapy should be continued even if the patient is using it for less than 4 hours per night. Educational, behavioral, and supportive interventions are recommended to improve PAP adherence in those with OSA. For chronic insomnia disorder, behavioral and psychological treatments are recommended, including cognitive behavioral therapy.

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“In all patients with sleep disorders, consultation with a sleep medicine specialist should be considered, especially for those in whom the diagnosis is uncertain or treatment proves challenging,” the authors write. “Future research combining therapies for OSA and insomnia is needed, and comparative effectiveness trials evaluating the relative benefits of different approaches are warranted.”

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