#APNEALINK DRIVER PORTABLE#
For people who screen positive, diagnostic polysomnography in a sleep facility or home-based testing with a portable monitor could be used to determine whether they have OSA. Potential screening strategies include questionnaires and clinical prediction tools that comprise combinations of subjective and objective findings. Screening to identify unrecognized OSA followed by appropriate treatment might improve sleep quality and normalize the AHI and oxygen saturation levels to prevent adverse health outcomes.
#APNEALINK DRIVER PLUS#
OSA is common, with prevalence around 15% in men and 5% in women (ages 30–70 years), based on either an apnea-hypopnea index (AHI) of 15 or greater or an AHI of 5 or greater plus symptoms of disturbed sleep. 8, 13, 14, 17 However, there is controversy in the literature regarding the extent to which OSA independently contributes to various outcomes beyond the contributions of age, body mass index (BMI), and other potential confounders. Obstructive sleep apnea (OSA) ( Table 1) has been associated with an increased risk of many adverse health outcomes, including motor vehicle crashes, 7-9 cognitive impairment, 10, 11 cardiovascular events, 12-14 atrial fibrillation, 15 stroke, 14, 16 and mortality. Trials of CPAP and other treatments have not established whether treatment reduces mortality or improves most other health outcomes, except for modest improvement in sleep-related quality of life. Multiple treatments for OSA reduce AHI, ESS scores, and blood pressure. In cohort studies, there was a consistent association between AHI and all-cause mortality.Ĭonclusions and Relevance: There is uncertainty about the accuracy or clinical utility of all potential screening tools. Common adverse effects of CPAP and MADs included oral or nasal dryness, irritation, and pain, among others. Mandibular advancement devices (MADs) and weight loss programs were also associated with reduced AHI and excessive sleepiness. CPAP was associated with modest improvement in sleep-related quality of life (Cohen d, 0.28 13 trials, 2325 participants). Meta-analysis found that continuous positive airway pressure (CPAP) compared with sham was significantly associated with reduction of AHI (weighted mean difference, −33.8 13 trials, 543 participants), excessive sleepiness assessed by ESS score (WMD, −2.0 22 trials, 2721 participants), diurnal systolic blood pressure (WMD, −2.4 points 15 trials, 1190 participants), and diurnal diastolic blood pressure (WMD, −1.3 points 15 trials, 1190 participants).
No studies prospectively evaluated screening tools to report calibration or clinical utility for improving health outcomes. In 2 studies (n=702), the screening accuracy of the multivariable apnea prediction score followed by home portable monitor testing for detecting severe OSA syndrome (AHI ≥30 and ESS score >10) was an AUC of 0.80 (95% CI, 0.78 to 0.82) and 0.83 (95% CI, 0.77 to 0.90), respectively, but the studies oversampled high-risk participants and those with OSA and OSA syndrome. No RCTs compared screening with no screening. Results: A total of 110 studies were included (N=46,188).
Main Outcomes and Measures: Sensitivity, specificity, area under the curve (AUC), AHI, Epworth Sleepiness Scale (ESS) scores, blood pressure, mortality, cardiovascular events, motor vehicle crashes, quality of life, and harms. When multiple similar studies were available, random-effects meta-analyses were conducted. Study Selection: English-language randomized clinical trials (RCTs) studies evaluating accuracy of screening questionnaires or prediction tools, diagnostic accuracy of portable monitors, or association between apnea-hypopnea index (AHI) and health outcomes among community-based participants.ĭata Extraction and Synthesis: Two investigators independently reviewed abstracts and full-text articles.
#APNEALINK DRIVER TRIAL#
Objective: To review primary care–relevant evidence on screening adults for OSA, test accuracy, and treatment of OSA, to inform the US Preventive Services Task Force.ĭata Sources: MEDLINE, Cochrane Library, EMBASE, and trial registries through October 2015, references, and experts, with surveillance of the literature through October 5, 2016. Importance: Many adverse health outcomes are associated with obstructive sleep apnea (OSA).
0 kommentar(er)
