Jury Still Out on Obstructive Sleep Apnea Screening

Megan Brooks

November 17, 2022

There remains insufficient evidence to weigh the balance of benefits and harms of screening for obstructive sleep apnea (OSA) among asymptomatic adults and those with unrecognized symptoms, the US Preventive Services Task Force (USPSTF) has concluded in an updated statement.

"Obstructive sleep apnea can negatively affect people's health and quality of life if left untreated. Unfortunately, after reviewing the existing research, the Task Force concluded that there is not enough evidence to recommend for or against screening adults who do not know they have signs or symptoms of sleep apnea," Task Force member Gbenga Ogedegbe, MD, NYU Langone Health in New York City, told Medscape Medical News.

Therefore, the Task Force issued an "I" statement (insufficient evidence), meaning it cannot at this time recommend for or against OSA screening. This matches the "I" statement the Task Force issued in 2017, as reported at the time by Medscape Medical News.

The final recommendation statement and corresponding evidence summary were published online November 15 in JAMA and on the Task Force website.

More Research Needed

To update its recommendation on OSA screening, Cynthia Feltner, MD, University of North Carolina at Chapel Hill, and colleagues reviewed 86 studies that included 11,051 participants.

The reviewers concluded that the accuracy and clinical utility of OSA screening tools that could be used in primary care settings were "uncertain."

They did find evidence that OSA treatment with positive airway pressure and mandibular advancement devices can lead to a reduction in daytime sleepiness, improve sleep-related and general health-related quality of life, and modestly reduce blood pressure by 2 to 3 mm Hg.

However, there is a lack of clinical trial evidence that treatment of OSA reduces risk for major adverse cardiovascular events or mortality, they note.

In the end, the Task Force concluded, as it did in 2017, that there currently is not enough evidence to recommend for or against OSA screening for the general adult population.

"Importantly, we need more research on the benefits and harms of screening people with no recognized symptoms of sleep apnea and how this screening might impact their health," Ogedegbe said.

"We are calling for more research on which risk assessment tools can help detect the patients that are most likely to benefit from screening. We also need to understand more about how sleep apnea develops from mild into severe cases, and the benefits of identifying and treating sleep apnea early," he added.

Ogedegbe noted that it is critical for clinicians to know that an "I" statement from the Task Force is not a recommendation for or against screening.

"Because the evidence is unclear on whether or not routine screening is beneficial, healthcare professionals should use their judgment when deciding who to screen," he said.

"In addition, we want to emphasize how important it is that anyone who has concerns about their sleep habits talks with their clinician so that they can get connected to the care they need," said Ogedegbe.

"Sensible," but Questions Remain

In an accompanying editorial, Daniel Gottlieb, MD, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, notes that OSA is "exceedingly" common in the adult US population.

"For the truly asymptomatic patient, the USPSTF recommendation is sensible, even for most patients with known cardiovascular illness," Gottlieb writes.

"However, the conflation of 'asymptomatic adults' and 'those with unrecognized OSA symptoms' is troubling, as it may suggest to clinicians that such unrecognized symptoms can be safely ignored," he adds.

Gottlieb notes that the USPSTF 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."

In addition, "strategies that involve broad application of diagnostic testing may soon be feasible," especially as "increasingly inexpensive and unobtrusive" home tests are available, he said.

"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," Gottlieb adds.

The USPSTF is an independent, voluntary body. The US Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF. All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings. Other relevant financial relationships for the members are listed in the original article. Gottlieb has served on scientific advisory boards for Signifier Medical Technologies and Wesper and as a consultant for Powell Mansfield Inc.

JAMA. Published online November 15, 2022. Full text, Editorial

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