Should primary care clinicians screen asymptomatic adults for obstructive sleep apnea, including those with unrecognized symptoms?
The US Preventive Services Task Force (USPSTF) continues to find that current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in adults without signs or symptoms of OSA (I statement). This recommendation focuses on persons who are not aware of their symptoms or do not report symptoms as being a concern. This updated review is consistent with the 2017 USPSTF recommendations.
Although severe obstructive sleep apnea (OSA) is significantly associated with increased all-cause mortality, it is unclear whether OSA is a causative factor independent of other risk factors (eg, older age, higher body mass index, and standard cardiovascular disease risk factors). Multiple screening tools are available for identifying OSA in asymptomatic adults and those with unrecognized symptoms, but it remains uncertain who will benefit from further testing in the primary care setting. Treatment with continuous positive airway pressure (CPAP) and dental devices reduces apneic events and blood pressure, and also improves sleepiness scores. However, the task force found no studies that directly evaluated the effect of screening for OSA on patient-oriented outcomes, such as mortality, cognitive impairment, motor vehicle crashes, and cardiovascular disease. CPAP can improve sleep-related quality of life in patients referred for treatment, but the value in screen-detected populations is unknown. The potential harms of CPAP and dental devices are small, although the risk of disease labeling with subsequent adverse consequences (eg, anxiety, insurance coverage) is always of concern. This recommendation does not apply to patients seeking care from their clinicians for specific symptoms, such as heavy snoring, witnessed apnea, excessive daytime fatigue, or impaired cognition. This recommendation on OSA is consistent with The American Academy of Family Physicians' recommendation. The American College of Physicians recommends a sleep study for patients with unexplained daytime sleepiness.
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Professor of Family Medicine, UNC Chapel Hill