Case Study

D.K., a 41-year-old man with a history of class 1 obesity (body mass index of 31 kg per m²), presents for a wellness visit. D.K. states he feels well today overall. D.K.’s uncle was recently diagnosed with obstructive sleep apnea (OSA), and D.K. has questions about screening for sleep apnea.

Case Study Questions

1. According to the U.S. Preventive Services Task Force (USPSTF) recommendation statement, is screening for OSA recommended for this patient?

• A. Yes, D.K. should be screened for OSA in your clinic today.

• B. Yes, D.K. should be referred to a sleep medicine specialist for polysomnography.

• C. No, screening for sleep apnea is not indicated in the general U.S. population.

• D. No, D.K. should be empirically treated with a positive airway pressure device or mandibular advancement device.

• E. There is not enough information to assess the benefits and harms of screening for OSA in adults.

2. Based on the USPSTF recommendation statement, which of the following statements are correct?

• A. There is inadequate evidence on the accuracy of screening approaches to identify adults in the general population at increased risk for OSA.

• B. There is adequate evidence of significant harms of screening for OSA.

• C. There is an absence of evidence on treatment with a positive airway pressure device or mandibular advancement device on intermediate health outcomes (e.g., apnea-hypopnea index) or sleep-related quality of life.

• D. There is inadequate evidence on the effect of treatment of OSA on health outcomes such as mortality or cardiovascular events because of a small number of studies with few events and inadequate follow-up.

3. The USPSTF recommendation statement on screening for obstructive sleep apnea in adults applies to which one of the following populations? [corrected]

• A. People undergoing workplace fitness-for-duty evaluations.

• B. People presenting with symptoms or concerns about OSA.

• C. People who are not aware of OSA symptoms or do not report symptoms as being a concern.

• D. People who have acute conditions that could trigger the onset of OSA (e.g., stroke).

Answers

1. The correct answer is E. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in the general adult population. This assessment is based on a lack of evidence on the accuracy of screening questionnaires and multistep screening approaches to identify adults in the general population at increased risk for OSA. An I statement is neither a recommendation for nor against screening. Physicians should continue to use their clinical judgment to determine whether additional evaluation or intervention is appropriate for individual patients.¹

2. The correct answers are A and D. The USPSTF found that there is inadequate evidence on the accuracy of screening questionnaires. Treatment with positive airway pressure improved some outcomes (i.e., apnea-hypopnea index, blood pressure, and sleep-related quality of life), but these studies were in populations referred for treatment. Evidence is lacking on the benefits of early detection and intervention in screen-detected populations. Additionally, the USPSTF found no significant benefit of treatment on mortality or cardiovascular events, likely because of limitations in the number of studies, number of events, and duration of follow-up. There is inadequate evidence regarding the harms of screening for OSA in the general adult population; no trials directly compared harms in screened vs. unscreened populations. Evidence on the harms of treatment in screen-detected populations was also limited.^1,2

3. The correct answer is C. The recommendation statement applies to adults 18 years or older without signs or symptoms of OSA, adults with unrecognized symptoms of OSA, or adults who are not aware of their symptoms or do not report symptoms as being a concern to their physician. It does not apply to people presenting with symptoms or concerns about OSA, people who have been referred for evaluation or treatment of suspected OSA, or people who have acute conditions that could trigger the onset of OSA (e.g., stroke). Care of these people should be managed as clinically appropriate. This recommendation also does not apply to children, adolescents, pregnant people, or people undergoing workplace fitness-for-duty evaluations.¹

The views expressed in this work are those of the authors and do not reflect the official policy or position of Johns Hopkins University, the Bloomberg School of Public Health, or the U.S. government.

This PPIP quiz is based on the recommendations of the USPSTF. More information is available in the USPSTF Recommendation Statement and supporting documents on the USPSTF website (https://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/obstructive-sleep-apnea-in-adults-screening.