The Journal of the American Medical Association (JAMA) have published new guidelines on diagnostic testing for obstructive sleep apnoea (OSA) in adults. The new guidelines, authored by Babak Mokhlesi and Adam S. Cifu at the University of Chicago, USA, include updated recommendations on the use of screening questionnaires, predictive algorithms, home sleep apnoea tests (HSAT) and facility-based polysomnography for diagnosing OSA.
Obstructive sleep apnea is characterised by recurrent episodes of complete (apnea) or partial (hypopnea) obstruction of the upper airway during sleep, affecting approximately 30 million adults in the USA.
The new JAMA guidelines suggest that screening questionnaires and prediction algorithms should not be used in lieu of facility-based polysomnography and HSAT, but rather should undergo diagnostic testing, particularly for patients with suspected moderate to severe OSA. “Although some screening questionnaires have high sensitivities,” the guidelines explain, “they are limited by low specificity and a low level of accuracy for diagnosis of OSA.”
For suspected moderate to severe OSA, the guidelines indicate that an HSAT can be administered for uncomplicated cases using a technically adequate device and while strictly adhering to the guidelines on what constitutes a technically adequate HSAT. A facility-based polysomnography is also deemed acceptable.
For complicated cases, however, HSATs are not recommended, and guidelines strongly favour facility-based polysomnography for patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspected sleep-related hypoventilation, chronic opioid medication use, history of stroke, or severe insomnia.
The guidelines also suggested that a split-night protocol might be beneficial for polysomnography, using half the night to diagnose OSA and the other half to titrate continuous positive airway pressure. Such a protocol, the guidelines offered, provides enhanced efficiency of care by diagnosing and establishing positive airway pressure therapy response within one night of recording.
The authors also highlighted the need for future research to assess cost-effectiveness and diagnostic accuracy as well as the clinical effectivenes of HSAT in a more diverse group of patients with various pretest probability of all severities of OSA.