Diagnosis of Obstructive Sleep Apnea in Adults
Authors: Paul Shekelle, Jon-Erik C. Holty, Thomas D. Denberg, Amir Qaseem
Journal: Annals of Internal Medicine (2015)

Letters17 March 2015Diagnosis of Obstructive Sleep Apnea in AdultsPaul Shekelle, MD, PhD, Jon-Erik C. Holty, MD, MS, Thomas D. Denberg, MD, PhD, and Amir Qaseem, MD, PhD, MHAPaul Shekelle, MD, PhDFrom Greater Los Angeles Veterans Affairs Health Center and RAND Corporation, Los Angeles, California; Stanford University, Stanford, California; Carilion Clinic, Roanoke, Virginia; and American College of Physicians, Philadelphia, Pennsylvania.Search for more papers by this author, Jon-Erik C. Holty, MD, MSFrom Greater Los Angeles Veterans Affairs Health Center and RAND Corporation, Los Angeles, California; Stanford University, Stanford, California; Carilion Clinic, Roanoke, Virginia; and American College of Physicians, Philadelphia, Pennsylvania.Search for more papers by this author, Thomas D. Denberg, MD, PhDFrom Greater Los Angeles Veterans Affairs Health Center and RAND Corporation, Los Angeles, California; Stanford University, Stanford, California; Carilion Clinic, Roanoke, Virginia; and American College of Physicians, Philadelphia, Pennsylvania.Search for more papers by this author, and Amir Qaseem, MD, PhD, MHAFrom Greater Los Angeles Veterans Affairs Health Center and RAND Corporation, Los Angeles, California; Stanford University, Stanford, California; Carilion Clinic, Roanoke, Virginia; and American College of Physicians, Philadelphia, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L15-5062-3 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Morgenthaler objects to the focus on unexplained daytime sleepiness as the symptom prompting investigation and suggests that other symptoms, including snoring, nonrefreshing sleep, morning headaches, impaired concentration, memory loss, and decreased libido, should prompt an evaluation for OSA. We disagree; many patients who present to a primary care practice have at least 1 of these symptoms, and they all do not need sleep studies. Unexplained daytime sleepiness is the only symptom of OSA that evidence from randomized, controlled trials shows is responsive to treatment. Population studies suggest that high rates of subjective sleepiness in the general population ...References1. Kapur VK, Baldwin CM, Resnick HE, Gottlieb DJ, Nieto FJ. Sleepiness in patients with moderate to severe sleep-disordered breathing. Sleep. 2005;28:472-7. [PMID: 16171292] CrossrefMedlineGoogle Scholar2. National Sleep Foundation. 2005 Sleep in America Poll: Summary of Findings. (Prepared by WBA Research.) Washington, DC: National Sleep Foundation; 2005. Accessed at http://sleepfoundation.org/sites/default/files/2005_summary_of_findings.pdf on 16 October 2014. Google Scholar3. Balk EM, Moorthy D, Obadan NO, Patel K, Ip S, Chung M, et al. Diagnosis and treatment of obstructive sleep apnea in adults. Comparative effectiveness review no. 32. AHRQ publication no. 11-EHC052-EF. (Prepared by Tufts Evidence-based Practice Center under contract 290-2007-100551.) Rockville, MD: Agency for Healthcare Research and Quality; 2011. Accessed at www.effectivehealthcare.ahrq.gov/ehc/products/117/683/CER32_SleepApnea_FinalReview_201108.pdf on 16 October 2014. Google Scholar4. Guerrero A, Embid C, Isetta V, Farre R, Duran-Cantolla J, Parra O, et al. Management of sleep apnea without high pretest probability or with comorbidities by three nights of portable sleep monitoring. Sleep. 2014;37:1363-73. [PMID: 25083017] doi:10.5665/sleep.3932 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Greater Los Angeles Veterans Affairs Health Center and RAND Corporation, Los Angeles, California; Stanford University, Stanford, California; Carilion Clinic, Roanoke, Virginia; and American College of Physicians, Philadelphia, Pennsylvania.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-3187. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDiagnosis of Obstructive Sleep Apnea in Adults: A Clinical Practice Guideline From the American College of Physicians Amir Qaseem , Paul Dallas , Douglas K. Owens , Melissa Starkey , Jon-Erik C. Holty , Paul Shekelle , and Diagnosis of Obstructive Sleep Apnea in Adults: A Clinical Practice Guideline From the American College of Physicians Amir Qaseem , Paul Dallas , Douglas K. Owens , Melissa Starkey , Jon-Erik C. Holty , Paul Shekelle , and Diagnosis of Obstructive Sleep Apnea in Adults Timothy I. Morgenthaler Diagnosis of Obstructive Sleep Apnea in Adults Jordanna M. Hostler , David C. Hostler , and Aaron B. Holley Diagnosis of Obstructive Sleep Apnea in Adults Timothy I. Morgenthaler Diagnosis of Obstructive Sleep Apnea in Adults Jordanna M. Hostler , David C. Hostler , and Aaron B. Holley Metrics 17 March 2015Volume 162, Issue 6Page: 456-457KeywordsDisclosureHealth care qualityHealth services researchQuestionnairesResearch quality assessmentSleepSleep apneaSleep disorders ePublished: 17 March 2015 Issue Published: 17 March 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...