阻塞性睡眠呼吸暂停(OSA)与不良健康结局相关。该项研究主要结果和测量指标:测试准确性，日间过度嗜睡，睡眠相关和一般健康相关生活质量(QOL)，以及危害。

纳入86项研究(N = 11051)。没有研究直接比较筛查和不筛查。五项评估其他筛查工具准确性的研究是不同的，结果也不一致。与非活动对照组相比，气道正压与ESS评分较基线显著改善相关(合并平均差异，-2.33 [95% CI， -2.75至-1.90];47试验;n = 7024)，与睡眠相关的生活质量(标准化平均差异，0.30 [95% CI, 0.19 - 0.42];17个试验;n = 3083)，一般健康相关的生活质量由36项简短健康调查(SF-36)精神健康成分总结评分变化测量

该试验可用于初级保健机构的OSA筛查工具的准确性和临床效用尚不确定。正压通气和下颌前移矫治可降低ESS评分。气道正压通气试验发现睡眠相关和一般健康相关QOL有小幅改善，但尚未确定治疗是否可降低死亡率或改善大多数其他健康结局

Abstract

Importance: Obstructive sleep apnea (OSA) is associated with adverse health outcomes.

Objective: To review the evidence on screening for OSA in asymptomatic adults or those with unrecognized OSA symptoms to inform the US Preventive Services Task Force.

Data sources: PubMed/MEDLINE, Cochrane Library, Embase, and trial registries through August 23, 2021; surveillance through September 23, 2022.

Study selection: English-language studies of screening test accuracy, randomized clinical trials (RCTs) of screening or treatment of OSA reporting health outcomes or harms, and systematic reviews of treatment reporting changes in blood pressure and apnea-hypopnea index (AHI) scores.

Data extraction and synthesis: Dual review of abstracts, full-text articles, and study quality. Meta-analysis of intervention trials.

Main outcomes and measures: Test accuracy, excessive daytime sleepiness, sleep-related and general health-related quality of life (QOL), and harms.

Results: Eighty-six studies were included (N = 11 051). No study directly compared screening with no screening. Screening accuracy of the Multivariable Apnea Prediction score followed by unattended home sleep testing for detecting severe OSA syndrome (AHI ≥30 and Epworth Sleepiness Scale [ESS] score >10) measured as the area under the curve in 2 studies (n = 702) was 0.80 (95% CI, 0.78 to 0.82) and 0.83 (95% CI, 0.77 to 0.90). Five studies assessing the accuracy of other screening tools were heterogeneous and results were inconsistent. Compared with inactive control, positive airway pressure was associated with a significant improvement in ESS score from baseline (pooled mean difference, -2.33 [95% CI, -2.75 to -1.90]; 47 trials; n = 7024), sleep-related QOL (standardized mean difference, 0.30 [95% CI, 0.19 to 0.42]; 17 trials; n = 3083), and general health-related QOL measured by the 36-Item Short Form Health Survey (SF-36) mental health component summary score change (pooled mean difference, 2.20 [95% CI, 0.95 to 3.44]; 15 trials; n = 2345) and SF-36 physical health component summary score change (pooled mean difference, 1.53 [95% CI, 0.29 to 2.77]; 13 trials; n = 2031). Use of mandibular advancement devices was also associated with a significantly larger ESS score change compared with controls (pooled mean difference, -1.67 [95% CI, 2.09 to -1.25]; 10 trials; n = 1540). Reporting of other health outcomes was sparse; no included trial found significant benefit associated with treatment on mortality, cardiovascular events, or motor vehicle crashes. In 3 systematic reviews, positive airway pressure was significantly associated with reduced blood pressure; however, the difference was relatively small (2-3 mm Hg).

Conclusions and relevance: The accuracy and clinical utility of OSA screening tools that could be used in primary care settings were uncertain. Positive airway pressure and mandibular advancement devices reduced ESS score. Trials of positive airway pressure found modest improvement in sleep-related and general health-related QOL but have not established whether treatment reduces mortality or improves most other health outcomes.

文章连接：

jamanetwork.com/journals/jama/fullarticle/2798400

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