Updated USPSTF Guidelines Show Benefits of Screening for Obstructive Sleep Apnea Do Not Outweigh Harms

The decision is updated from a 2017 recommendation to screen people for obstructive sleep apnea, which can lead to daytime sleepiness and other adverse outcomes.

In a recent review, the US Preventive Services Task Force (USPSTF) said that cases of obstructive sleep apnea (OSA) rose 442% from 1999 and 2010, according to data from to the National Ambulatory Medical Care Survey. However, there is not enough evidence to support screening the general population for OSA, according to the USPSTF.

“Obstructive sleep apnea is associated with multiple adverse health outcomes such as cognitive impairment, motor vehicle crashes, lost workdays, work disability, impaired work performance, and decreased quality of life,” the USPSTF said in a paper published in JAMA Network Open.

OSA may also lead to cardiovascular disease, type 2 diabetes, and metabolic syndrome, the USPSTF explained. But obesity appears to be the root cause of most of the recent growth in cases.

OSA is a sleep disorder that results in airway obstruction during sleep. Apnea is experiencing a period of total airway obstruction that can last 10 seconds or more, but a more serious condition is hypopnea, in which blood oxygen saturation decreased by 3%.

The USPSTF examined the benefits and harms of OSA screening in a systematic review. They also looked at the benefits and harms of treatment on blood pressure and health outcomes— which include mortality, quality of life, cardiovascular events, and cognitive impairment— but did not find anything that directly evaluated the association between health outcomes and screening.

There are a multitude of possible screening questionnaires, including 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,” the study authors said in the report; however, none have been proven more beneficial.

OSA risk factors include male sex, older ages between 40 and 70 years, postmenopausal status, higher body mass index (BMI), and craniofacial and upper airway abnormalities. Obesity, asthma, and tobacco may increase OSA risk—it has been suggested these risk factors are higher among Black, Latinx, and Native American/Alaska Native populations.

OSAs are primarily treated using positive airway pressure devices, relying on compressed air to maintain an open airway. In 3 systematic reviews, 1 linked positive airway pressure to reducing daytime blood pressure, while the other 2 showed blood pressure reduction over a mean of 24-hours. A second treatment option is the Mandibular advancement device.

Screening is generally considered safe by the USPSTF. The recommendation is primarily for adults aged 18 years and older, specifically among those who are not concerned about OSA, have been recommended evaluation for the condition, or have conditions that may trigger OSA.

“The 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,” the study authors wrote in the report.

Reference

US Preventative Services Task Force. Screening for Obstructive Sleep Apnea in Adults. JAMA. 2022;328(19):1945-1950. doi:10.1001/jama.2022.20304

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