Screening for Obstructive Sleep Apnea

Abstract

Obstructive sleep apnea (OSA) is highly prevalent, affecting 34% of men and 17% of women. 1 Individuals with OSA experience recurrent cardiometabolic stress when repetitively attempting to breathe against an occluded airway during sleep, leading to nightly episodes of hypoxia, sleep disruption, and surges of the sympathetic nervous system. These physiological perturbations often cause blood pressure and heart rate elevations, endothelial dysfunction, and insulin resistancemechanisms implicated in the pathogenesis of cardiovascular disease (CVD), diabetes, and neurologic disease. 2 When untreated, OSA is associated with an increased risk for incident hypertension, CVD, stroke, and mortality, 3 as well as increased sleepiness, motor vehicle crashes, and mood disorders and reduced quality of life. 4,5 Given its association with CVD, OSA has been proposed as a novel intervention target for reducing morbidity and mortality rates. The quest, however, to improve health by treating OSA requires rigorous research that evaluates the role of OSA interventions in large groups of patients followed up for long periods. Advancing this research agenda requires validated tools for screening appropriate populations and the availability of interventions that effectively treat OSA.In this issue of JAMA, the US Preventive Services Task Force (USPSTF) presents recommendations for screening asymptomatic primary care patients for OSA. 6 Based on a commissioned systematic review, 7 the USPSTF concluded that "the current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in asymptomatic adults. (I statement)" 6 The determination of insufficient evidence was due to the absence of randomized trials assessing the effect of screening and of treatment on clinical outcomes; suboptimal performance characteristics of existing screening instruments; and concern over residual confounding in observational studies. 6,7 The high prevalence of undiagnosed OSA and its attendant morbidity and mortality provide a strong impetus to improve recognition of this disorder. Community-based studies demonstrate that OSA is highly prevalent and underdiagnosed across population groups, especially minorities. Among 14 440 participants in the Hispanic Community Health Study, prevalence of OSA was found to be 25.8% when participants underwent sleep testing. 8 In contrast, only 1.3% of cohort members reported an OSA diagnosis. Similarly, in a community sample of more than 2200

Prevalence of and characteristics associated with insomnia and obstructive sleep apnea among veterans with knee and hip osteoarthritis

“…Consistent with the literature for both conditions, our results suggest a significant gap between the presence of insomnia and OSA symptoms and documented diagnoses [ 43 ]. Sleep concerns may be minimized or overlooked in primary care visits, particularly when greater attention is devoted to other chronic conditions..…”

Obstructive Sleep Apnea Phenotypes and Markers of Vascular Disease: A Review

“…The AHI combines apneas and hypopneas associated with hypoxemia. Yet, other sleep metrics (i.e., oxygen nadir, arousal frequency), along with clinical symptoms and molecular markers could be better predictors of stroke and CVD outcomes in OSA ( 17 – 19 ). The heterogeneity of clinical presentations leads to the evaluation of OSA phenotypes as a strategy to identify at-risk individuals for stroke and CVD ( 18 , 19 ).…”

“…Yet, other sleep metrics (i.e., oxygen nadir, arousal frequency), along with clinical symptoms and molecular markers could be better predictors of stroke and CVD outcomes in OSA ( 17 – 19 ). The heterogeneity of clinical presentations leads to the evaluation of OSA phenotypes as a strategy to identify at-risk individuals for stroke and CVD ( 18 , 19 ). As defined in the article by Zinchuk et al, a phenotype is “a category of patients with OSA distinguished from others by a single or combination of disease features, in relation to clinically meaningful attributes (symptoms, response to therapy, health outcomes, quality of life)” ( 20 ).…”

“…The high prevalence of undiagnosed OSA and its resultant stroke and CVD risk provide a strong impetus to develop better risk-stratification strategies ( 18 , 19 ). There is a need to further define the OSA phenotypes that may differentially affect stroke and or CVD risk.…”

Dreams and Nightmares in Patients With Obstructive Sleep Apnea: A Review

“…OSA is associated with adverse health outcomes, including decreased quality of life, insulin resistance, and increased risk for cardiometabolic disorders and mortality (5). Excessive daytime sleepiness (EDS) is a major consequence of OSA that often constitutes a risk factor for motor vehicle crashes (6).…”