Insufficient evidence prevents OSA screening recommendation
medwireNews: The US Preventive Services Task Force (USPSTF) has issued an “I” statement regarding screening for obstructive sleep apnea (OSA) in adults, concluding that the current evidence is insufficient to assess the balance of benefits and harms.
The task force reviewed a total of 100 studies, involving 46,188 participants. The aim was to assess the potential benefit of screening for OSA in asymptomatic patients, including those with unrecognized symptoms, in the primary care setting as a way of reducing the growing burden of untreated OSA
OSA questionnaires and clinical prediction tools, such as the Berlin Questionnaire and the Multivariable Apnea Prediction tool, exist but their accuracy could not be adequately validated in the primary care setting, report Daniel Jonas (University of North Carolina at Chapel Hill, USA) and team in JAMA.
Evidence of a benefit with treatment with continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) was at least adequate for immediate outcomes, but not for other health outcomes, such as cardiovascular disease and mortality, cerebrovascular events, and all-cause mortality.
In terms of harm, direct evidence for screening was limited, although adequate evidence was found to indicate it is small for CPAP and MADs treatment.
In one of three related editorials in the journal, Susan Redline (Harvard Medical School, Boston, Massachusetts, USA) stresses that the current recommendation should not be misinterpreted.
“Encouraging patient and clinician discussion of relevant symptoms and signs of OSA is one way to help address early recognition,” she says, adding: “[P]rimary care clinicians have an important role in mitigating the adverse health consequences of OSA that can ensue from years of unrecognized disease.”
In agreement, editorialist Gregory Carter (University of Texas Southwestern Medical Center, Dallas, USA) writes in JAMA Neurology that the goal of the USPSTF is “worthy of the support of all clinicians,” but he recognizes that “it will be challenging.” He highlights that beneficial health outcomes might be seen if patients with acute conditions that could trigger OSA, such as stroke or pregnancy, are included and if compliance with CPAP treatment is improved.
By Lucy Piper
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