Clinical Edge

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Screening for Obstructive Sleep Apnea in Adults

JAMA; ePub 2017 Jan 24; US Preventive Service Task Force

The US Preventive Services Task Force (USPSTF) has issued a new recommendation statement on screening for obstructive sleep apnea (OSA) in adults. Based on the evidence reviewed for accuracy, benefits, and potential harms of screening for OSA in asymptomatic adults seen in primary care, the USPSTF concluded:

  • Current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in asymptomatic adults. (I statement).

The USPSTF also determined that evidence on screening tools to accurately detect persons in asymptomatic populations who should receive further testing and treatment of subsequently diagnosed OSA to improve health outcomes is lacking, and the balance of benefits and harms cannot be determined.

Citation:

US Preventive Services Task Force. Screening for obstructive sleep apnea in adults. US Preventive Services Task Force recommendation statement. JAMA. 2017;317(4):407-414. doi:10.1001/jama.2016.20325.

Commentary:

The prevalence of OSA among adults in the United States is approximately 10% for mild OSA and 5% for moderate to severe OSA. OSA is a common cause of daytime fatigue and the presence of untreated OSA correlates with increased rates of diabetes, cognitive impairment, decreased quality of life, and motor vehicle crashes. There is evidence that treatment of OSA in symptomatic individuals improves the apnea-hypopnea index, decreases daytime drowsiness, and improves blood pressure. However, there is no evidence that detecting OSA through screening among individuals who do not present with symptoms yields any benefit. It is for this reason that screening is not recommended. We should have a low threshold for thinking about OSA when patients present either with symptoms or in the right clinical setting such as a large neck and/or difficult to control hypertension, but currently the data does not support screening. —Neil Skolnik, MD

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