USPSTF Obstructive Sleep Apnea Screening Recommendations

Authors:
US Preventive Services Task Force.
Citation:
Screening for Obstructive Sleep Apnea in Adults: US Preventive Services Task Force Recommendation Statement. JAMA 2017;317:407-414.

The US Preventive Services Task Force (USPSTF) is a voluntary body of national experts in evidence-based medicine. The following are points to remember about the USPSTF Recommendation Statement on Screening for Obstructive Sleep Apnea (OSA) in Adults:

  1. In the United States, approximately 1 in 10 adults has mild OSA, and between 3-7% have moderate to severe OSA. Given the obesity epidemic, the numbers may actually be higher.
  2. Prevalence among asymptomatic adults is not known.
  3. Two broad adult populations were discussed: symptomatic and asymptomatic. Those referred to a sleep laboratory were defined as symptomatic (i.e., snoring, witnessed apnea, daytime sleepiness, gasping at night). The population of interest to the USPSTF is the asymptomatic population in primary care practices who is not referred to sleep centers.
  4. Adequate evidence exists that treatment of OSA with continuous positive airway pressure (CPAP) can improve intermediate outcomes: defined as apnea-hypopnea index [AHI], Epworth sleepiness scale, and blood pressure among a symptomatic population sent for evaluation of OSA.
  5. The Task Force did not find adequate evidence linking the benefit of change in intermediate outcomes and reduction in health outcomes (i.e., mortality).
  6. Adequate evidence exists to support the use of mandibular advancement devices (MADs) to improve intermediate outcomes among those with symptoms of OSA, but not on health outcomes.
  7. There is inadequate evidence for use of surgical treatment for improving intermediate or mortality outcomes in OSA.
  8. Potential harms of treatments were discussed. The harm of CPAP included: local irritation, epistaxis, or pain. Inadequate evidence exists to comment on the harm of surgical treatment of OSA. Harms from MAD include jaw discomfort, oral, or mucosal symptoms.
  9. Final gap in evidence: Screening tools to assess risk for OSA among the asymptomatic population have not been adequately validated in primary care practices.
  10. Studies adequately powered with long enough follow-up to conclude whether treatment of OSA leads to improvement in health outcomes are needed.
  11. This Recommendation Statement does not pertain to children, adolescents, or pregnant women.
  12. As with similar statements or guidelines, physicians should understand the evidence presented, but should tailor individual treatment based on specific patient presentations.
  13. Take-home message: The Task Force could not find evidence to support screening for or treatment of OSA in asymptomatic adults.

Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Sleep Apnea

Keywords: Blood Pressure, Continuous Positive Airway Pressure, Epistaxis, Evidence-Based Medicine, Mandibular Advancement, Metabolic Syndrome X, Obesity, Primary Health Care, Primary Prevention, Sleep Apnea, Obstructive, Sleep Apnea Syndromes, Snoring


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