AHRQ Effective Health Care Program - Research Reviews

Comparative Effectiveness of Diagnosis and Treatment of Obstructive Sleep Apnea in Adults
Key questions published 7 Oct 2009

Draft Key Questions
1. How do different available tests compare to diagnose sleep apnea in adults with symptoms suggestive of disordered sleep?

How do the different tests compare in different subgroups of patients, based on:
race, gender, body mass index (BMI), existing non-insulin dependent diabetes mellitus (NIDDM), existing cardiovascular disease (CVD), existing hypertension (HTN), clinical symptoms, previous stroke, airway characteristics

What is the agreement between various combinations of clinical signs, symptoms, and history and formal testing?

2. How does phased testing (screening tests or battery followed by full test) compare to full testing alone?

3. What is the effect of pre-operative screening for sleep apnea on surgical outcomes?

4. What is the comparative effect of different treatments for obstructive sleep apnea (OSA) in adults?

Does the comparative effect of treatments vary based on presenting patient characteristics, severity of OSA, or other pre-treatment factors? Are any of these characteristics or factors predictive of treatment success?

Characteristics: Age, sex, race, weight, bed partner, airway and other physical characteristics, specific comorbidities
OSA severity or characteristics: Baseline questionnaire (etc.) results, formal testing results (including hypoxemia levels), Baseline QoL; positional dependency, REM dependency
Other: specific symptoms

Does the comparative effect of treatments vary based on the definitions of OSA used by study investigators?

5. What are the pre-treatment patient-level characteristics associated with failure to adequately treat OSA?

6. What is the effect of interventions to improve compliance with device (CPAP, oral appliances, positional therapy) use on clinical and intermediate outcomes?



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AHRQ Effective Health Care Program - Research Reviews