Science in the News
U.S. Preventive Services Task Force Report Finds Insufficient Evidence to Support Screening of Asymptomatic Individuals for Obstructive Sleep Apnea
January 24, 2017
An evidence report/systematic review1
from the U.S. Preventive Services Task Force (USPSTF) concluded that the current evidence is insufficient (i.e., an “I” recommendation statement2
) to assess the balance of benefits and harms of screening for obstructive sleep apnea (OSA) in asymptomatic adults in primary care settings, including those with unrecognized symptoms. This includes adults who are not aware of their symptoms or do not report symptoms as being a concern to their clinician. The report explicitly states that this recommendation does not apply to adults who present with symptoms (e.g., snoring, witnessed apnea, excessive daytime sleepiness, impaired cognition, mood changes, or gasping or choking at night) or who have concerns about OSA, people who have been referred for evaluation or treatment of suspected OSA, or those who have acute conditions that could trigger the onset of OSA (e.g., stroke) and recommends that care of these persons should be managed as clinically appropriate. This statement also explicitly does not apply to children, adolescents, or pregnant women.
The systematic review evaluated the evidence on the accuracy, benefits, and potential harms of screening for OSA in asymptomatic adults (18 years of age and older) seen in primary care, including those with unrecognized symptoms. The review also evaluated the evidence on the benefits and harms of treatment of OSA on both intermediate outcomes (e.g., change in the apnea/hypopnea index [AHI], sleepiness, and blood pressure) and health outcomes such as mortality, quality of life, cardiovascular and cerebrovascular events, and cognitive impairment. A total of 110 studies were included (total enrolled N=46,188). No eligible studies directly evaluated the effectiveness or adverse outcomes of OSA screening compared with no screening. USPSTF found at least adequate evidence that treatment with continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) can improve intermediate outcomes (e.g., the AHI, Epworth Sleepiness Scale score, and blood pressure) in populations referred for treatment. However, the applicability of the evidence to screen-detected populations (i.e., asymptomatic individuals or those with unrecognized symptoms) is limited.
In a co-published editorial in JAMA
Redline suggests that “high priority should be given to additional studies that generate rigorous evidence that will serve to improve the recognition and treatment of OSA in the population and reduce its attendant morbidity” and that “Encouraging patient and clinician discussion of relevant symptoms and signs of OSA is one way to help address early recognition.”
- Jonas DE, Amick HR, Feltner C, et al. Screening for Obstructive Sleep Apnea in Adults. JAMA 2017;317(4):415.
- Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for Obstructive Sleep Apnea in Adults. JAMA 2017;317(4):407.
- Redline S. Screening for obstructive sleep apnea: Implications for the sleep health of the population. JAMA 2017;317(4):368-70.
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