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Diagnosis of Obstructive Sleep Apnea in Adults: A Clinical Practice Guideline From the American College of Physicians FREE

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The full report is titled “Diagnosis of Obstructive Sleep Apnea in Adults: A Clinical Practice Guideline From the American College of Physicians.” It is in the 5 August 2014 issue of Annals of Internal Medicine (volume 161, pages 210-220). The authors are A. Qaseem, P. Dallas, D.K. Owens, M. Starkey, J.E.C. Holty, and P. Shekelle, for the Clinical Guidelines Committee of the American College of Physicians.

Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.

Ann Intern Med. 2014;161(3):I-28. doi:10.7326/P14-9025
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Who developed these recommendations?

The American College of Physicians (ACP) developed these recommendations. Members of the ACP are internists, specialists in the care of adults.

What is the problem and what is known about it so far?

People with sleep apnea have episodes of blockage of their upper airways during sleep. The condition results in abnormal sleep and low blood oxygen during the night. Sleep apnea is common, especially among people who are overweight or obese. Many people with the condition experience daytime sleepiness, trouble sleeping at night, or snoring. They can also develop high blood pressure and other heart problems.

Several types of studies, called “sleep studies,” are now available to evaluate patients suspected of having sleep apnea. During a sleep study, the patient sleeps either at a specialized laboratory (for a test called a polysomnogram) or at home or in the hospital (for a test called a portable sleep study). Each test monitors several parameters that help an expert decide whether sleep apnea or another kind of sleep problem is present. The ACP wanted to review what is known about these tests in order to make recommendations about their use for evaluating patients suspected of having sleep apnea.

How did the ACP develop these recommendations?

The ACP reviewed published studies that provide information about how well each type of sleep test performs in diagnosing sleep apnea.

What did the authors find?

Sleep studies performed in specialized laboratories have been the standard method to diagnose sleep apnea. Other types of studies that involve portable equipment and are done in patients' homes have been used; however, their results vary widely, and no definitive studies have been conducted that compare each type of test with the others. In addition, certain portable sleep studies are unable to determine what type of sleep apnea a patient has, which might determine which treatment is best. How well each study performs may be influenced by whether a patient has other serious, chronic medical conditions, and no good studies have been done to assess how well portable studies do in such patients.

What does the ACP recommend that patients and doctors do?

Patients with daytime sleepiness that is not explained by other causes should have a sleep study to determine whether sleep apnea is present.

A polysomnogram should be used to evaluate patients suspected of having sleep apnea. If a polysomnogram is not available, a portable sleep study should be performed if the patient does not have any serious, chronic medical problems.

What are the cautions related to these recommendations?

These recommendations were based on studies published through May 2013 and may change as more information about options to diagnose sleep apnea becomes available.





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