Task force again declines to recommend OSA screening

The evidence base on screening for obstructive sleep apnoea has again been declared too weak to make a definitive recommendation either for or against in asymptomatic adults.

The statement by the US Preventive Services Task Force (link here) echoes a similar finding by the group five years ago, although it does suggest some “case finding” may be justified for those at higher risk.

Nevertheless, a literature review failed to identify enough evidence to determine if screening all adults improved either health or quality of life, the task force reported in JAMA this week.

“Most patients do not discuss sleep habits or sleep-related symptoms with their primary care clinicians,” said taskforce member Professor Martha Kubik of George Mason University school of nursing.

“Since the evidence on screening all adults for sleep apnoea is limited, healthcare professionals should use their judgment when deciding who to screen, and patients who have concerns about their sleeping should talk to their healthcare professional about their symptoms.”

The USPSTF literature review (link here) included 86 studies covering more than 11,000 patients, although none directly compared screening with no screening.

It found only uncertain accuracy and clinical utility of OSA screening tools that could be used in primary care settings such as Multivariable Apnoea Prediction score followed by unattended home sleep testing for detecting severe OSA syndrome or Epworth Sleepiness Scale (ESS) scoring.

On the other hand, positive airway pressure and mandibular advancement devices had a positive impact on ESS scores.

Trials of positive airway pressure found “modest improvement” in sleep-related and general health-related quality but had not established whether treatment reduced mortality or improved most other health outcomes, the task force found.

All in all, the report correctly highlighted the need for rigorous research to identify optimal primary care screening strategies, said Associate Professor Daniel Gottlieb of Harvard Medical School’s division of sleep medicine.

Studies were also warranted to determine whether there were any benefits to routine screening of asymptomatic or mildly symptomatic patients, he wrote in an accompanying editorial (link here).

“Given the high prevalence of OSA in the general adult population and the availability of increasingly inexpensive and unobtrusive home diagnostic testing modalities, strategies that involve broad application of diagnostic testing may soon be feasible,” he wrote.

However, it was important for research to focus on identifying those patients most likely to benefit from treatment, including in specialist settings, Professor Gottlieb said.

“For example, OSA screening has become a routine part of the presurgical evaluation and the evaluation of patients with atrial fibrillation.”

“Although OSA is common in both settings and is associated with worse clinical outcomes, the benefit of screening for and treatment of OSA in these settings remains to be demonstrated.”

He added: “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 unrecognised.”

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