Health outcomes of OSA:
  • Severe OSA (AHI ≥30 events/hr) is a predictor of all-cause mortality (HR = 1.5–3.0). Image clinapneafu1.jpg
    • One study showed that this correlation was not seen in men >70 years of age or in women.
  • A high baseline AHI is correlated with diabetes (OR = 2.81–4.06). Image clinapneafu3.jpg
Detection of OSA:
  • At-home monitors* accurately predict elevated AHI suggestive of OSA (but cannot estimate exact AHI values as measured by sleep-laboratory PSG/Type I monitors):
    • Type II monitors. Image clinapneafu3.jpg
    • Type III and IV monitors. Image clinapneafu2.jpg
    • There is insufficient evidence to compare the types of at-home monitors. Image clinapneafu4.jpg
  • The Berlin Questionnaire may be accurate in screening for OSA. Image clinapneafu3.jpg
  • Some clinical prediction rules (a morphometric model and a pulmonary function data model) may have predictive capacity, but these tools have not been validated externally. Image clinapneafu3.jpg
  • There is insufficient evidence at this time to evaluate the effectiveness of most questionnaires, including the commonly used STOP and STOP-Bang questionnaires, in aiding diagnosis. Image clinapneafu4.jpg
Additional Findings
  • There is insufficient evidence to evaluate:
    • The effectiveness of phased testing in aiding diagnosis. Image clinapneafu4.jpg
    • The usefulness of preoperative screening for OSA in improving postoperative outcomes. Image clinapneafu4.jpg
Treatment of OSA:
  • CPAP and MAD are effective treatments for OSA (e.g., they improve sleepiness and lower AHI values). CPAP is superior to MAD in achieving an AHI of ≤5 events/hr. Image clinapneafu2.jpg
    • Studies of MAD predominately exclude patients with comorbidities or unsafe levels of sleepiness.
    • Evidence is insufficient to address which patients might benefit most from treatment with CPAP, MAD, or CPAP compared to MAD. Image clinapneafu4.jpg
  • Types of positive airway pressure machines:
    • AutoCPAP and fixed CPAP are equally effective. Image clinapneafu2.jpg
    • Evidence is insufficient to compare other CPAP devices (oral CPAP, nasal CPAP, bilevel PAP, flexible bilevel PAP, and humidified CPAP or autoCPAP). Image clinapneafu4.jpg
  • The studies for surgical interventions are limited, and while some studies show efficacy of individual interventions, current evidence is insufficient to determine their relative effectiveness when compared to each other, to sham or no treatment, or to other OSA interventions. Image clinapneafu4.jpg
Other Treatments
  • Weight-loss programs may be an effective treatment for OSA (vs. control interventions) in patients who are obese. Image clinapneafu3.jpg
  • There is insufficient evidence to compare the relative effectiveness of other treatments for OSA, such as implants, exercises, positional approaches, and nasal dilator strips. Image clinapneafu4.jpg
  • Compliance with OSA treatments:
    • High AHI and ESS are predictors of improved CPAP compliance. Image clinapneafu2.jpg
    • Evidence is insufficient to evaluate potential predictors of MAD compliance. Image clinapneafu4.jpg

Type II monitors record the same information as PSG, Type III have at least two respiratory channels, and Type IV is any portable monitor that fails to meet the requirements of Type II or III classification.

Current research evaluates only intermediate outcomes, and thus these messages may not apply to long-term clinical outcomes.

From: Comparative Effectiveness of Diagnosis and Treatment of Obstructive Sleep Apnea in Adults

Cover of Comparative Effectiveness Review Summary Guides for Clinicians
Comparative Effectiveness Review Summary Guides for Clinicians [Internet].

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