After posting its draft statement for comment earlier this year, the US Preventive Services Task Force (USPSTF) has now released its final recommendation statement on screening for obstructive sleep apnea in asymptomatic people ages 18 and older.
Consistent with its now-archived statement in 2017, the USPSTF again concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for obstructive sleep apnea in the general adult population.
“The task force looked at the evidence on screening for sleep apnea because it can negatively affect people’s health, and it is tied to other serious health issues like heart disease and stroke,” says task force member Gbenga Ogedegbe, MD, MPH, in a release. “Unfortunately, there is not enough evidence to determine if screening all adults for sleep apnea improves health and quality of life.”
In the final statement materials, the USPSTF addressed some of the comments posted to its draft recommendation, which was open for comments from March 29, 2022, to April 25, 2022. It said, “Some comments expressed concern that the recommendation statement does not adequately differentiate persons who are asymptomatic from those with unrecognized symptoms. In response, the USPSTF added clarifying language to describe common symptoms of OSA [obstructive sleep apnea] and defined what is meant by persons with unrecognized symptoms. Comments also proposed that the USPSTF call for screening in patients considered at higher risk. The USPSTF recognizes that certain groups are at increased risk of OSA but did not find any studies that directly evaluated the effect of screening for OSA on health outcomes.
“The USPSTF wishes to clarify that its I statement is neither a recommendation for nor against screening. Clinicians should continue to use their clinical judgment to determine if screening is appropriate for individual patients.
“Comments asked why the recommendation statement focused only on positive airway pressure and MADs [mandibular advancement devices] and excluded surgical interventions. The focus of this recommendation is first-line therapies for OSA. Surgical therapies are typically reserved for patients who do not respond to first-line therapies or have more severe symptoms (and thus are less likely to be asymptomatic or referred from primary care).
“Several respondents asked the USPSTF to specify the types of studies it needs to fill evidence gaps and to consider study types other than RCTs [randomized controlled trials]. The USPSTF wishes to clarify that there are no generic criteria (ie, only considering RCTs) for the types of evidence it would consider for review. The criteria for consideration depend on the type and quality of evidence the USPSTF needs to make an accurate determination of benefits and harms of delivering a preventive health service.”
In a separate section, the USPSTF stated that more studies on sleep apnea screening are needed that address the following specific areas.
- Well-designed studies of OSA screening in asymptomatic populations representative of the US primary care population that evaluate the benefits and harms of screening on health outcomes (eg, mortality, cardiovascular disease events, motor vehicle crashes, and quality of life) in screened vs unscreened persons.
- Accuracy studies of screening tools in a general US adult primary care population, especially in persons with unrecognized or mild symptoms.
- Development of accurate risk assessment tools that can identify populations most likely to benefit from OSA screening.
- More data on the natural history of OSA; in particular, the rates of progression from mild to severe OSA, the length of duration before progression, and the magnitude of benefit if OSA is identified and treated earlier.
Most primary care clinicians do not routinely screen for sleep apnea, and most patients do not discuss sleep-related symptoms with their primary care clinicians, the USPSTF noted.
This recommendation does not apply to persons presenting with symptoms or concerns about OSA, persons who have been referred for evaluation or treatment of suspected OSA, or persons who have acute conditions that could trigger the onset of OSA (eg, stroke). Care of these persons should be managed as clinically appropriate. This recommendation also does not apply to children, adolescents, or pregnant persons.
Recommendations made by the USPSTF are independent of the US government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.