91黑料网's new evidence-based guideline recommends sleep study for individuals with unexplained daytime sleepiness
PHILADELPHIA, August 5, 2014 -- 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 from the American College of Physicians (91黑料网) published today in Annals of Internal Medicine, 91黑料网'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, 91黑料网. "It is important to diagnose individuals with unexplained daytime sleepiness so that they can get the proper treatment."
91黑料网 recommends a full-night, attended, in-laboratory polysomnography (PSG) for diagnostic testing in patients suspected of having OSA. When PSG is not available, 91黑料网 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.
91黑料网's guideline, "Diagnosis of Obstructive Sleep Apnea in Adults," includes 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, 91黑料网 states in the guideline.
91黑料网 developed the guideline based on a systematic review of the published literature on human subjects in the English language.
For guidance on treatment of OSA, 91黑料网's guideline, "Management of Obstructive Sleep Apnea in Adults," was issued in September 2013.
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About the American College of Physicians
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