Screening for Obstructive Sleep Apnea: Should We Do It?
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Purpose of Review
Obstructive sleep apnea (OSA) is prevalent and underdiagnosed. It is associated with significant comorbidities and early detection and treatment might lead to improvement in important clinical outcomes. This paper will review current evidence on screening for OSA in the primary care setting and in certain high-risk groups.
The 2017 United States Preventative Services Taskforce evidence review on OSA screening noted a lack of high-quality evidence linking OSA screening with important clinical outcomes and on the accuracy of proposed screening tools.
OSA symptoms are usually not discussed in the primary care setting. A screening tool such as a questionnaire is a simple approach that could be easily implemented in this setting. Further study into the long-term cardiovascular and mortality benefits of the treatment of OSA, randomized controlled trials linking the implementation of screening and improvement in important clinical outcomes, and the accuracy of available screening tools as well as their generalizability to the primary care population is needed to improve the strength of their recommendation and their adoption.
KeywordsObstructive sleep apnea OSA Screening Primary care Berlin questionnaire STOP-BANG
Compliance with Ethical Standards
Conflict of Interest
Sara Pasha declares no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 12.Mold JW, Quattlebaum C, Schinnerer E, Boeckman L, Orr W, Hollabaugh K. Identification by primary care clinicians of patients with obstructive sleep apnea: a practice-based research network (PBRN) study. J Am Board Fam Med. 2011;24(2):138–45. https://doi.org/10.3122/jabfm.2011.02.100095.CrossRefPubMedGoogle Scholar
- 17.Gottlieb DJ, Yenokyan G, Newman AB, O'Connor GT, Punjabi NM, Quan SF, et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation. 2010;122(4):352–60. https://doi.org/10.1161/CIRCULATIONAHA.109.901801.CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Giles TL, Lasserson TJ, Smith BJ, White J, Wright J, Cates CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev. 2006.Google Scholar
- 26.Redline S, Baker-Goodwin S, Bakker JP, Epstein M, Hanes S, Hanson M, et al. Sleep apnea patient-centered outcomes network. Patient partnerships transforming sleep medicine research and clinical care: perspectives from the sleep apnea patient-centered outcomes network. J Clin Sleep Med. 2016;12(7):1053–8.CrossRefGoogle Scholar
- 31.Burgess KR, Havryk A, Newton S, Tsai WH, Whitelaw WA. Targeted case finding for OSA within the primary care setting. J Clin Sleep Med. 2013;9(7):681e6.Google Scholar
- 32.Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263e76.Google Scholar
- 33.Knauert M, Naik S, Gillespie MB, Kryger M. Clinical consequences and economic costs of untreated obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 2015;1:17–27.Google Scholar
- 37.Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108(5):812e21.Google Scholar
- 39.• Miller JN, Berger AM. Screening and assessment for obstructive sleep apnea in primary care. Sleep Med Rev. 2016;29:41–51. https://doi.org/10.1016/j.smrv.2015.09.005. Epub 2015. This article is a comprehensive review of the sensitivity, specificity, and diagnostic accuracy of several commonly used screening questionnaires. The study reported inconsistent psychometric findings for OSA screening measures with a lack of validation research in primary care.
- 40.• Qaseem A, Dallas P, Owens DK, Starkey M, Holty JC, Shekelle P. Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians. A review of studies aimed at determining the accuracy of level II, III, and IV portable devices as well as screening questionnaires when compared to polysomnography for the diagnosis of OSA. The conclusions of the authors were limited by the absence of high-quality evidence. Google Scholar
- 41.Chiu HY, Chen PY, Chuang LP, Chen NH, Tu YK, Hsieh YJ, et al. Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: a bivariate meta-analysis. Sleep Med Rev. 2017;36:57–70. https://doi.org/10.1016/j.smrv.2016.10.004.CrossRefPubMedGoogle Scholar
- 42.•• Jonas DE, Amick HR, Feltner C, Weber RP, Arvanitis M, Stine A, et al. Screening for obstructive sleep apnea in adults: evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2017;317(4):415–33. https://doi.org/10.1001/jama.2016.19635 This is a comprehensive USPSTF commissioned systematic review of the current evidence on screening for obstructive sleep apnea. It includes literature on the accuracy of various screening tools and diagnostic tests and on OSA treatment outcomes.CrossRefPubMedGoogle Scholar
- 57.Federation ID. The IDF Consensus statement on sleep apnoea and type 2 diabetes. Brussels: International Diabetes Federation; (2008).Google Scholar
- 58.Donovan LM, Rueschman M, Weng J, Basu N, Dudley KA, Bakker JP, et al. The effectiveness of an obstructive sleep apnea screening and treatment program in patients with type 2 diabetes. Diabetes Res Clin Pract. 2017;134:145–52. https://doi.org/10.1016/j.diabres.2017.10.013.CrossRefPubMedPubMedCentralGoogle Scholar
- 69.Tantrakul V, Numthavaj P, Guilleminault C, McEvoy M, Panburana P, Khaing W, et al. Performance of screening questionnaires for obstructive sleep apnea during pregnancy: a systematic review and meta-analysis. Sleep Med Rev. 2017;36:96–106. https://doi.org/10.1016/j.smrv.2016.11.003.CrossRefPubMedGoogle Scholar
- 72.Continuous positive airway pressure (CPAP) for sleep apnea in pregnancy (SLEEP). ClinicalTrials.gov Identifier: NCT03487185.
- 83.Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2014;120:268–86.Google Scholar
- 84.Gurubhagavatula I, Sullivan S, Meoli A, Patil S, Olson R, Berneking M, et al. Management of obstructive sleep apnea in commercial motor vehicle operators: recommendations of the AASM Sleep and Transportation Safety Awareness Task Force. J Clin Sleep Med. 2017;13(5):745–58. https://doi.org/10.5664/jcsm.6598.CrossRefPubMedPubMedCentralGoogle Scholar
- 86.Pack A, Dinges D, Maislin G (2002) A study of prevalence of Sleep Apnea among commercial truck drivers. Publication no. DOT-RT-02–030. Federal Motor Carrier Safety Administration, Washington, DC.Google Scholar
- 92.Hartenbaum N, Collop N, Rosen IM, et al. Sleep apnea and commercial motor vehicle operators: statement from the joint Task Force of the American College of Chest Physicians, American College of Occupational and Environmental Medicine, and the National Sleep Foundation. J Occup Environ Med. 2006;48(9Suppl):S4–S37.CrossRefGoogle Scholar
- 93.Ancoli-Israel S, Czeisler CA, George CF, Guilleminault C, Pack AI. Expert panel recommendations: obstructive sleep apnea and commercial motor vehicle driver safety. Federal Motor Carrier Safety Administration website. https://cms.fmcsa.dot.gov/regulations/medical/expert-panel-recommendationsobstructive-sleep-apnea-and-commercial-motor. Published 2008.
- 94.January 28, 2008 MRB Meeting Summary. Federal Motor Carrier Safety Administration website. https://www.fmcsa.dot.gov/january-28-2008-mrbmeeting-summary. Published April 7, 2008. Updated November 24, 2009.
- 95.Proposed recommendations on obstructive sleep apnea. Federal Motor Carrier Safety Administration website. https://www.fmcsa.dot.gov/regulations/ notices/2012–9555. Published April 20, 2012.
- 96.Final Report: OSA (MCSAC/MRB February 2012 meeting) (Task 11–05). Federal Motor Carrier Safety Administration website. https://www.fmcsa.dot. gov/advisory-committees/mcsac/final-report-osa-mcsacmrb-february-2012- meeting-task-11-05-0. Published February 21,2012.