Screening for Obstructive Sleep Apnea in Adults

Jonas, Daniel E; Amick, Halle R; Feltner, Cynthia; Weber, Rachel Palmieri; Arvanitis, Marina; Stine, Alexander; Lux, Linda J; Middleton, Jennifer Cook; Voisin, C; Harris, Russell

doi:10.1001/jama.2022.18357

Cited by 35 publications

(68 citation statements)

References 162 publications

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“…Potential screening questionnaires and clinical prediction tools include the Epworth Sleepiness Scale (ESS), STOP questionnaire (snoring, tiredness, observed apnea, high blood pressure), STOP-BANG questionnaire (STOP questionnaire plus BMI, age, neck circumference, and gender), Berlin Questionnaire, Wisconsin Sleep Questionnaire, and the Multivariable Apnea Prediction tool . However, none of these instruments have been adequately validated in general populations enrolled from primary care settings …”

Section: Practice Considerationsmentioning

confidence: 99%

“…Persons with suspected OSA are usually diagnosed using polysomnography, which combines several measurements, including an electroencephalogram, electro-oculogram, chin electromyelogram, airflow monitor, oxygen saturation, respiratory effort, and electrocardiogram or heart rate . Additional recommended measurements include body position and leg movements .…”

Section: Practice Considerationsmentioning

confidence: 99%

“…A positive airway pressure device, which uses compressed air to maintain the airway, is the primary treatment for OSA . For patients with overweight and obesity, weight loss is also recommended .…”

Section: Practice Considerationsmentioning

confidence: 99%

“…For patients with overweight and obesity, weight loss is also recommended . Mandibular advancement devices (MADs) are an alternative therapy to positive airway pressure for patients with OSA who prefer them or for those with adverse effects associated with positive airway pressure . Surgical interventions for OSA are available, but they generally are not considered first-line treatments …”

Section: Practice Considerationsmentioning

confidence: 99%

“…This is primarily attributed to the increase in prevalence of obesity . Obstructive sleep apnea is associated with multiple adverse health outcomes such as cognitive impairment, motor vehicle crashes, lost work days, work disability, impaired work performance, and decreased quality of life . Obstructive sleep apnea has also been associated with cardiovascular disease (eg, coronary heart disease, stroke, or hypertension), type 2 diabetes, and metabolic syndrome .…”

Section: Practice Considerationsmentioning

confidence: 99%

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Screening for Obstructive Sleep Apnea in Adults

Mangione

Barry

Nicholson

et al. 2022

JAMA

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ImportanceCurrent prevalence of obstructive sleep apnea (OSA) in the US is not well established; however, based on cohort and survey data, in 2007-2010 the estimated prevalence of at least mild OSA (defined as an apnea-hypoxia index [AHI] ≥5) plus symptoms of daytime sleepiness among adults aged 30 to 70 years was 14% for men and 5% for women, and the estimated prevalence of moderate to severe OSA (defined as AHI ≥15) was 13% for men and 6% for women. Severe OSA is associated with increased all-cause mortality. Other adverse health outcomes associated with untreated OSA include cardiovascular disease and cerebrovascular events, type 2 diabetes, cognitive impairment, decreased quality of life, and motor vehicle crashes.ObjectiveTo update its 2017 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for OSA in adults.PopulationAsymptomatic adults (18 years or older) and adults with unrecognized symptoms of OSA.Evidence AssessmentThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in the general adult population.RecommendationThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in the general adult population. (I statement)

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Section: Practice Considerationsmentioning

confidence: 99%

Section: Practice Considerationsmentioning

confidence: 99%

Section: Practice Considerationsmentioning

confidence: 99%

Section: Practice Considerationsmentioning

confidence: 99%

Section: Practice Considerationsmentioning

confidence: 99%

See 3 more Smart Citations

Screening for Obstructive Sleep Apnea in Adults

Mangione

Barry

Nicholson

et al. 2022

JAMA

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Screening for Obstructive Sleep Apnea in Adults

Jonas¹,

Amick²,

Feltner³

et al. 2022

JAMA

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ImportanceObstructive sleep apnea (OSA) is associated with adverse health outcomes.ObjectiveTo review the evidence on screening for OSA in asymptomatic adults or those with unrecognized OSA symptoms to inform the US Preventive Services Task Force.Data SourcesPubMed/MEDLINE, Cochrane Library, Embase, and trial registries through August 23, 2021; surveillance through September 23, 2022.Study SelectionEnglish-language studies of screening test accuracy, randomized clinical trials (RCTs) of screening or treatment of OSA reporting health outcomes or harms, and systematic reviews of treatment reporting changes in blood pressure and apnea-hypopnea index (AHI) scores.Data Extraction and SynthesisDual review of abstracts, full-text articles, and study quality. Meta-analysis of intervention trials.Main Outcomes and MeasuresTest accuracy, excessive daytime sleepiness, sleep-related and general health–related quality of life (QOL), and harms.ResultsEighty-six studies were included (N = 11 051). No study directly compared screening with no screening. Screening accuracy of the Multivariable Apnea Prediction score followed by unattended home sleep testing for detecting severe OSA syndrome (AHI ≥30 and Epworth Sleepiness Scale [ESS] score &gt;10) measured as the area under the curve in 2 studies (n = 702) was 0.80 (95% CI, 0.78 to 0.82) and 0.83 (95% CI, 0.77 to 0.90). Five studies assessing the accuracy of other screening tools were heterogeneous and results were inconsistent. Compared with inactive control, positive airway pressure was associated with a significant improvement in ESS score from baseline (pooled mean difference, −2.33 [95% CI, −2.75 to −1.90]; 47 trials; n = 7024), sleep-related QOL (standardized mean difference, 0.30 [95% CI, 0.19 to 0.42]; 17 trials; n = 3083), and general health–related QOL measured by the 36-Item Short Form Health Survey (SF-36) mental health component summary score change (pooled mean difference, 2.20 [95% CI, 0.95 to 3.44]; 15 trials; n = 2345) and SF-36 physical health component summary score change (pooled mean difference, 1.53 [95% CI, 0.29 to 2.77]; 13 trials; n = 2031). Use of mandibular advancement devices was also associated with a significantly larger ESS score change compared with controls (pooled mean difference, −1.67 [95% CI, 2.09 to −1.25]; 10 trials; n = 1540). Reporting of other health outcomes was sparse; no included trial found significant benefit associated with treatment on mortality, cardiovascular events, or motor vehicle crashes. In 3 systematic reviews, positive airway pressure was significantly associated with reduced blood pressure; however, the difference was relatively small (2-3 mm Hg).Conclusions and RelevanceThe accuracy and clinical utility of OSA screening tools that could be used in primary care settings were uncertain. Positive airway pressure and mandibular advancement devices reduced ESS score. Trials of positive airway pressure found modest improvement in sleep-related and general health–related QOL but have not established whether treatment reduces mortality or improves most other health outcomes.

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Screening for Obstructive Sleep Apnea in Adults

Gottlieb

2022

JAMA

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An association of extreme obesity with hypersomnolence was recognized in antiquity and described in the early 19th century in both medical texts and, most famously, in Dickens' Posthumous Papers of the Pickwick Club. However, not until the first polysomnographic recordings of sleep and respiration were made in the 1960s was it recognized that apneas resulting from intermittent obstruction of the upper airway during sleep, causing hypoxemia and cortical arousal, contributed to the excessive sleepiness in these so-called "Pickwickian" patients. 1 The term "obstructive sleep apnea syndrome" was coined the following decade, and it was soon recognized that intermittent partial airway obstruction during sleep, resulting in reduced airflow (hypopnea) without apnea, could result in an identical clinical syndrome.Although obstructive sleep apnea syndrome was initially considered an uncommon condition, epidemiology studies in the 1990s revealed that apneas and hypopneas during sleep are quite common in the general adult population. 2 In 1999 the American Academy of Sleep Medicine (AASM) published a task force report that defined "obstructive sleep apnea-hypopnea syndrome" as a condition characterized by an elevated frequency of apneas and hypopneas during sleep (the apnea-hypopnea index [AHI]) plus bothersome symptoms, most notably excessive sleepiness, fatigue, or unrefreshing sleep. The severity of this syndrome was classified along 2 axes: severity of sleepiness and frequency of obstructive events. 3 Since that time, however, the requirement for symptoms has been largely dropped from the standard sleep disorders nosology: the diagnosis of adult obstructive sleep apnea (OSA) is made if the AHI is 15 or more events per hour of sleep regardless of associated clinical features, while for those with an AHI between 5 and 15 events per hour, the list of associated symptoms, signs, and comorbid conditions supporting the diagnosis of OSA has been expanded to include insomnia symptoms, habitual snoring, hypertension, diabetes, cardiovascular disease, and mood disorder, among others 4 -a list so broad that an AHI of 5 or greater has become a de facto sufficient criterion for diagnosis of OSA.Thus defined, OSA is exceedingly common in the adult population. As of 2010, OSA was conservatively estimated to affect 34% of men and 17% of women between the ages of 30 and 70 years in the US 5 -estimates that would be consid-

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Screening for Obstructive Sleep Apnea in Adults

Cited by 35 publications

References 162 publications

Screening for Obstructive Sleep Apnea in Adults

Screening for Obstructive Sleep Apnea in Adults

Screening for Obstructive Sleep Apnea in Adults

Screening for Obstructive Sleep Apnea in Adults

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