USPSTF: Evidence insufficient on risks, benefits of sleep apnea screening

There is still not enough evidence to make a recommendation for or against obstructive sleep apnea screening in asymptomatic adults, according to a statement from the U.S. Preventive Services Task Force.

The I recommendation statement, published in JAMA, aligns with the task force’s 2017 decision, and calls for more research on whether screening people who do not show symptoms for obstructive sleep apnea (OSA) — which include excessive daytime sleepiness, loud snoring and suddenly waking up with feelings of choking or gasping — can improve their health.

“The task force looked at the evidence on screening for sleep apnea because it can negatively affect people’s health, and it is tied to other serious health issues like heart disease and stroke,” task force member Gbenga Ogedegbe, MD, MPH, the inaugural and founding director of the Institute for Excellence in Health Equity at NYU Langone Health and the Dr. Adolph and Margaret Berger Professor of Medicine and Population Health at NYU Grossman School of Medicine, said in a press release. “Unfortunately, there is not enough evidence to determine if screening all adults for sleep apnea improves health and quality of life.”

The recommendation statement was based on a systematic review of 86 studies that included just over 11,000 people. After reviewing the evidence, the task force determined that “the accuracy and clinical utility of OSA screening tools that could be used in primary care settings were uncertain.”

“Most patients do not discuss sleep habits or sleep-related symptoms with their primary care clinicians,” task force member Martha Kubik, PhD, RN, a professor at the School of Nursing, College of Health and Human Services at George Mason University, said in the release. “Since the evidence on screening all adults for sleep apnea is limited, health care professionals should use their judgment when deciding who to screen, and patients who have concerns about their sleeping should talk to their health care professional about their symptoms.”

In an accompanying editorial, Daniel J. Gottlieb, MD, MPH, of the division of sleep and circadian disorders at Brigham and Women’s Hospital, wrote that the report “correctly highlights the need for rigorous research to identify optimal screening strategies for OSA in the primary care setting and to determine whether routine screening of asymptomatic or mildly symptomatic patients leads to improved clinical outcomes.”

“While much remains to be learned about the potential benefits of screening for asymptomatic OSA, this should not deter clinicians from identifying and appropriately managing the care of the many symptomatic patients whose OSA symptoms are currently unrecognized,” he wrote.

References:

Feltner C, et al. JAMA. 2022;doi:10.1001/jama.2022.18357.

Gottlieb D, et al. JAMA. 2022;doi:10.1001/jama.2022.20670.

USPSTF. JAMA. 2022;doi:10.1001/jama.2022.20304.

U.S. Preventive Services Task Force issues final recommendation statement on screening for obstructive sleep apnea in adults. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/sleep-apnea-screening-final-rec-bulletin.pdf. Published Nov. 15, 2022. Accessed Nov. 15, 2022.