Doctors should assess the risk factors for and the symptoms of obstructive sleep apnea (OSA) in patients with unexplained daytime sleepiness, according to a new evidence-based clinical practice guideline from the American College of Physicians (ACP) published in Annals of Internal Medicine, ACP's flagship journal.
"Obstructive sleep apnea is a serious health condition that is associated with cardiovascular disease, hypertension, cognitive impairment, and type 2 diabetes," said Dr. David Fleming, president, ACP. "It is important to diagnose individuals with unexplained daytime sleepiness so that they can get the proper treatment."
ACP recommends a full-night, attended, in-laboratory polysomnography (PSG) for diagnostic testing in patients suspected of having OSA. When PSG is not available, ACP recommends using a home-based portable monitor.
Obesity is the best documented risk factor for OSA. Symptoms of OSA include unintentional sleep episodes during wakefulness, daytime sleepiness, unrefreshing sleep, fatigue, insomnia, and snoring.
OSA is caused by repetitive obstruction of the upper airway during sleep, resulting in reduced airflow (hypopnea) or complete airflow cessation (apnea). According to the National Heart, Lung, and Blood Institute, 12 to 18 million adults in the United States have sleep apnea. The incidence of OSA is rising, likely because of the increasing rates of obesity. The incidence of OSA increases with age, particularly in adults over the age of 60.
ACP's guideline, "Diagnosis of Obstructive Sleep Apnea in Adults," includes High Value Care advice to help doctors and patients understand the benefits, harms, and costs of tests and treatment options so they can pursue care together that improves health, avoids harms, and eliminates wasteful practices.
"Diagnosing obstructive sleep apnea is high value care," Dr. Fleming said. "Prior to diagnosis, patients with obstructive sleep apnea have higher rates of health care use, more frequent and longer hospital stays, and greater health care costs than after diagnosis."
Assessing patients for OSA in the absence of daytime sleepiness or treating individuals with low apnea-hypopnea index (AHI) scores is low value care because the evidence indicates that it does not improve clinical outcomes, ACP states in the guideline.
ACP developed the guideline based on a systematic review of the published literature on human subjects in the English language.
- Amir Qaseem, Paul Dallas, Douglas K. Owens, Melissa Starkey, Jon-Erik C. Holty, Paul Shekelle. Diagnosis of Obstructive Sleep Apnea in Adults: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine, 2014; 161 (3): 210 DOI: 10.7326/M12-3187
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