USPSTF: Insufficient evidence for obstructive sleep apnea screening

According to the U.S. Preventive Services Task Force, there is a lack of high-quality evidence to support screening for obstructive sleep apnea in asymptomatic adults, indicating that the degree of the benefits or harms of screening could not be determined.

“Obstructive sleep apnea (OSA) has been associated with an increased risk of many adverse health outcomes, including motor vehicle crashes, cognitive impairment, cardiovascular events, atrial fibrillation, stroke and mortality,” Daniel E. Jonas, MD, MPH, of the department of medicine at the University of North Carolina at Chapel Hill and colleagues wrote in the evidence report. “However, there is controversy in the literature regarding the extent to which OSA independently contributes to various outcomes beyond the contributions of age, BMI and other potential confounders.”

The I-grade statement, published in JAMA, was based on a systematic review of 110 studies including 46,188 individuals. The task force reviewed the evidence on the accuracy, benefits and potential harms of screening for OSA in asymptomatic adults or those with unrecognized symptoms seen in primary care, as well as the benefits and harms of OSA treatment on intermediate and final health outcomes.

Overall, the USPSTF found inadequate evidence on the benefits and harms of screening for or treatment of OSA in asymptomatic adults using validated screening questionnaires and all other potential screening tools. This critical gap in evidence was due to a lack of randomized trials that evaluated the effect of screening and treatment on clinical outcomes, substandard performance of existing screening tools and apprehension about confounding in observational studies.

In addition, the task force found that in populations referred for treatment, there is at least adequate evidence that intermediate outcomes, such as the apnea-hypopnea index, Epworth Sleepiness Scale score and BP, can be enhanced through treatment with continuous positive airway pressure and mandibular advancement devices. However, there is limited applicability of this evidence for screen-detected populations.

In an accompanying editorial, Susan Redline, MD, MPH, of the division of sleep and circadian disorders at Brigham and Women’s Hospital, wrote that to improve the treatment of OSA and reduce its associated morbidity, it is crucial that additional studies be conducted in a manner that provides rigorous evidence.

“The current recommendations, if misinterpreted, could negatively influence public health if they are used to discourage direct questioning or deployment of short screening questionnaires for identifying patients at high risk for OSA,” she added. “Encouraging patient and clinician discussion of relevant symptoms and signs of OSA is one way to help address early recognition. Although increasing the likelihood of early recognition is not without its challenges, primary care clinicians have an important role in mitigating the adverse health consequences of OSA that can ensue from years of unrecognized disease.” – by Alaina Tedesco

Reference:

Jonas DE, et al. JAMA. 2016;doi:10.1001/jama.2016.19635.

Redline S. JAMA. 2016;doi:10.1001/jama.2016.18630.

USPSTF. JAMA. 2016;doi:10.1001/jama.2016.20325.

Disclosure: USPSTF reports funding from the AHRQ and HHS. Redline reports serving on the board of directors for the American Academy of Sleep Medicine and receiving support from Jazz Pharmaceuticals and Beckman Company.