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ACP's new evidence-based guideline recommends sleep study
for individuals with unexplained daytime sleepiness
Video News Story | Read
Guideline | Read
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
clinical practice guideline from the American College of
Physicians (ACP) published today in Annals of Internal
Medicine, ACP'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, ACP. "It is important to diagnose individuals with
unexplained daytime sleepiness so that they can get the proper
ACP recommends a full-night, attended, in-laboratory
polysomnography (PSG) for diagnostic testing in patients suspected
of having OSA. When PSG is not available, ACP 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
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.
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.
"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
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, ACP states in the guideline.
ACP 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, ACP's guideline, "Management of Obstructive Sleep Apnea in
Adults," was issued in September 2013.
About the American College of Physicians
The American College of Physicians is the largest
medical specialty organization and the second-largest physician
group in the United States. ACP members include 141,000 internal
medicine physicians (internists), related subspecialists, and
medical students. Internal medicine physicians are specialists who
apply scientific knowledge and clinical expertise to the diagnosis,
treatment, and compassionate care of adults across the spectrum
from health to complex illness. Follow ACP on Twitter and Facebook.