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) being published in Annals of Internal Medicine (http://www.annals.org/article.aspx?doi=10.7326/M12-3187).
Up to 18 million adults in the United States have OSA, a serious health condition that is associated with cardiovascular disease (CVD), cognitive impairment, and type 2 diabetes. OSA is caused by repetitive obstruction of the upper airway during sleep, resulting in reduced airflow (hypopnea) or complete airflow cessation (apnea). Symptoms include unintentional sleep episodes during wakefulness, daytime sleepiness, unrefreshing sleep, fatigue, insomnia, and snoring. The incidence of OSA increases with age, particularly in adults over the age of 60, and obesity is a key risk factor.
To diagnose OSA in symptomatic patients, ACP recommends a full-night, attended, in-laboratory polysomnography (PSG) for diagnostic testing. When PSG is not available, ACP recommends using a home-based portable monitor.
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.