The U.S. Preventive Services Task Force yesterday published a final recommendation statement and evidence summary on screening for obstructive sleep apnea (OSA) in asymptomatic adults in primary care settings. This recommendation statement applies to people without symptoms or who do not recognize their symptoms of OSA. After reviewing the evidence, the Task Force concluded that there is not enough evidence to determine whether screening for OSA in adults leads to improved health outcomes. This is an I statement, which means “the balance of benefits and harms cannot be determined.”
“This is the first time that the Task Force has reviewed the evidence on screening for OSA,” says Task Force member Alex H. Krist, MD, MPH, in a release. “OSA represents a major health concern; it affects 10 to 15% of the US population and is associated with heart disease, diabetes, reduced quality of life, and increased risk of death. Primary care doctors want to know if screening is beneficial for patients. Unfortunately, right now, there is not enough evidence to know.”
The Task Force recommendation does not apply to adults who have symptoms of or concerns about OSA, or who have an acute condition that could trigger the onset of OSA, such as a stroke. It also does not apply to children, adolescents, or pregnant women.
“The Task Force is calling for more research among primary care patients on whether screening adults without known symptoms leads to improvements in health outcomes,” says Jessica Herzstein, MD, MPH, a coauthor of the recommendation, “Clinicians should use their clinical judgment when deciding whether or not to screen their patients for OSA.”
The Task Force’s recommendation has been published online in JAMA, as well as on the Task Force website. A draft version of the recommendation was available for public comment from June 14 to July 11, 2016.
The Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.
Krist is an associate professor of family medicine and population health at Virginia Commonwealth University and an active clinician and teacher at the Fairfax Family Practice Residency. He is codirector of the Virginia Ambulatory Care Outcomes Research Network and director of community-engaged research at the Center for Clinical and Translational Research. Herzstein, a board-certified specialist in preventive medicine and internal medicine, is an independent consultant in occupational, environmental, and preventive health.
AASM Response to “Screening for Obstructive Sleep Apnea in Adults: Evidence Report”
Obstructive sleep apnea (OSA) is a highly prevalent disease that remains underdiagnosed and undertreated. Although the U.S. Preventive Services Task Force found no studies comparing screened and unscreened populations of asymptomatic adults or persons with unrecognized symptoms of OSA,1 the American Academy of Sleep Medicine recommends screening patients who have a high risk for OSA, even if they don’t have any sleep-related symptoms.2,3
Primary care providers are in the best position to identify patients with symptoms of OSA, such as excessive daytime sleepiness and snoring, gasping, choking, or pauses in breathing during sleep. Indicators of high risk for OSA include obesity, heart problems such as congestive heart failure and atrial fibrillation, treatment resistant hypertension, Type 2 diabetes, and stroke.
Identification by primary care providers of patients who have a high risk for OSA, followed by appropriate referral to a board-certified sleep medicine physician for a comprehensive sleep history and evaluation, could significantly reduce the frequency of undiagnosed OSA. Screening high-risk populations for OSA could improve the quality of life and health outcomes for these patients while also reducing the individual and public health burden of untreated OSA. It is estimated that diagnosing and treating every patient in the U.S. who has OSA would produce an annual economic savings of $100.1 billion.4
The National Healthy Sleep Awareness Project developed a self-assessment tool that can help patients identify the common symptoms of sleep apnea and understand their risk factors for OSA. It is available online at www.sleepeducation.org/healthysleep/resources-for-health-care-professionals.
This statement summarizes the comments that the AASM submitted to the USPSTF on June 27, 2016.
1. Jonas DE, Amick HR, Feltner C, et al. Screening for obstructive sleep apnea in adults: evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2017;317(4):415-433.
2. Epstein LJ, Kristo D, Strollo PJ, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263-276.
3. Aurora RN, Quan SF. Quality measure for screening for adult obstructive sleep apnea by primary care physicians. J Clin Sleep Med. 2016;12(8):1185-1187.
4. Frost & Sullivan; American Academy of Sleep Medicine. Hidden health crisis costing America billions: underdiagnosing and undertreating obstructive sleep apnea draining health care system. Published Aug. 8, 2016.