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Diagnosis and treatment of obstructive sleep apnea in adults

Balk, Ethan
United States Agency for Healthcare Research and Quality
Tufts Evidence-based Practice Center
Effective Health Care Program (US)
Diagnosis and treatment of obstructive sleep apnea in adultsĀ [electronic resource] / prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Tufts Evidence-based Practice Center, Tufts Medical Center ; investigators, Ethan M. Balk ... [et al.].
Comparative effectiveness review ; no. 32
AHRQ publication ; no. 11-EHC052
Country of Publication:
United States
Rockville, MD : Agency for Healthcare Research and Quality, [2011]
1 online resource : ill.
Electronic Links:
BACKGROUND: Methods for diagnosing and treating obstructive sleep apnea (OSA) are cumbersome, resource-intensive, and often inconvenient for the patient. PURPOSE: Systematically review the evidence on OSA diagnosis and treatment in adults. The Key Questions focus on OSA screening and diagnosis, treatments, associations between apnea-hypopnea index (AHI) and clinical outcomes, and predictors of treatment compliance. DATA SOURCES: MEDLINE(r), Cochrane Central Register of Controlled Trials, and existing systematic and narrative reviews. STUDY SELECTION: Primarily prospective comparative studies of different tests, randomized controlled trials of treatments, and multivariable association studies. Only published, peer-reviewed, English-language articles were selected and manually screened based on predetermined eligibility criteria. DATA EXTRACTION: A standardized protocol was used to extract details on design, diagnoses, interventions, outcomes, and quality. DATA SYNTHESIS: In total, 234 studies met eligibility criteria (46 on diagnostic tests, 17 predictor studies, 190 on treatments). We found moderate evidence that portable monitors are accurate in diagnosing OSA (as defined by polysomnography), but retain a variable bias in estimating AHI; low strength of evidence that the Berlin Questionnaire is able to prescreen patients with OSA with moderate accuracy; and insufficient evidence to evaluate other questionnaires or clinical prediction rules. No study adequately addressed phased testing for OSA. There was insufficient evidence on routine preoperative testing for OSA. High strength of evidence indicates an AHI >30 events/hr is an independent predictor of death; lesser evidence for other outcomes. We found moderate evidence that continuous positive airway pressure (CPAP) is an effective treatment for OSA; moderate evidence that autotitrating and fixed CPAP have similar effects; insufficient evidence regarding comparisons of other CPAP devices; moderate evidence that oral devices are effective treatment for OSA; moderate evidence that CPAP is superior to oral devices; and insufficient trial evidence regarding the relative value of most other OSA interventions, including surgery. We found high and moderate evidence, respectively, that AHI and Epworth Sleepiness Scale are independent predictors of CPAP compliance, and low evidence that some treatments improve CPAP compliance. LIMITATIONS: Very few trials evaluated objective clinical outcomes. Data were meager for many specific questions. Studies were generally of moderate to poor quality, and often had short followups, high dropout rates, and poor analyses and reporting. CONCLUSIONS: Portable monitors and questionnaires may be effective screening tools, but assessments with clinical outcomes are necessary to prove their value over polysomnography. CPAP is highly effective in minimizing AHI and improving sleepiness. Oral devices are also effective, although not as effective as CPAP. Other interventions, including those to improve compliance, have not been adequately tested.
Comparative Effectiveness Research
Evidence-Based Medicine
Randomized Controlled Trials as Topic
Sleep Apnea, Obstructive/diagnosis*
Sleep Apnea, Obstructive/therapy*
Treatment Outcome
Publication Type(s):
"Contract No. 290-2007-10055-1."
"July 2011."
Includes bibliographical references.
Also issued in print.
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 540 Gaither Road, Rockville, MD 20850; Contract No. 290-2007-10055-1, Prepared by: Tufts Evidence-based Practice Center, Tufts Medical Center, Boston, MA.
Description based on online resource; title from PDF title page (viewed on Jan. 13, 2012).
101574669 [Electronic Resource]

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