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New AHRQ Comparative Effectiveness Review of Sleep Apnea Diagnosis & Treatment


Sleep Research Society
Friday, August 12, 2011

The U.S. Department of Health and Human Services' (HHS) Agency for Healthcare Research and Quality (AHRQ) has released a new comparative effectiveness review that examines sleep apnea diagnosis and treatment. This report is based on a systematic review of 234 clinical studies, 190 of which related to sleep apnea treatment.

Comparative Effectiveness Review of the Diagnosis and Treatment of Obstructive Sleep Apnea in Adults, prepared by researchers at the AHRQ-supported Tufts Evidence-based Practice Center systematically reviewed evidence addressing key questions on obstructive sleep apnea (OSA) diagnosis and treatment. Key findings include:

  • OSA has been correlated with all-cause mortality and diabetes. More specifically, severe OSA, defined as an Apnea-Hypopnea Index (AHI) greater than or equal to 30 events/hour is a predictor of all-cause mortality and a high baseline AHI is correlated with diabetes.
  • CPAP remains the most effective treatment for sleep apnea and is superior to MAD in improving sleepiness and lowering AHI values.
  • In order to be effective, the CPAP must be used during every sleep session. CPAP treatment suffers from low compliance, but there is insufficient evidence to evaluate compliance with other treatment options.
  • MADs also improve sleepiness and lower AHI values, and can still serve as a treatment option for OSA, although they are not as effective as CPAP. MADs also have side effects of their own.
  • Other treatment options, such as surgery and drug therapy, are available, and they may be effective, but there is insufficient evidence to compare the effectiveness and safety of these treatment options. The research notes that all treatment options carry side effects.
  • Weight-loss programs seem to be a promising treatment for OSA, for patients who are obese.

Given more than 12 million Americans suffer from OSA, which dramatically impacts quality of life, greater efforts, including clinical trials, are warranted to address the current gaps in knowledge related to assessing the effectiveness of sleep apnea treatments. The information in this CER, including the discussion of current research needs, may help inform future research in this area.

AHRQ's new materials on sleep apnea were developed by the Agency's Effective Health Care Program, which represents an important Federal effort to compare treatments for health conditions and make the findings public. The program is intended to help patients, doctors, nurses, pharmacists, and others work together to choose the most effective treatments. Visit www.effectivehealthcare.ahrq.gov  to read this report, learn more about AHRQ's patient-centered outcomes research and download other materials.