Is it Necessary to Test for or Treat Sleep Apnea without other Symptoms?

The US Preventive Services Task Force states it is not clear whether people without symptoms should be evaluated or treated for obstructive sleep apnea. I agree. We should not go out and test everyone for sleep apnea. We probably should not treat everyone who has sleep apnea.

What are the symptoms that should lead us to test for sleep apnea?

If you do not snore, you probably do not have obstructive sleep apnea. If you snore, then testing should be done if:

1.       The snoring is loud

2.       A bedpartner has heard you stop breathing in sleep

3.       You are tired or sleepy during the day

4.       You are obese or have a large neck

5.       You have atrial fibrillation

6.       You have type 2 diabetes

7.       You have coronary artery disease

8.       You have had a stroke

9.       You have irregular heart beat at night

10.   You have high blood pressure

Otherwise, simple snoring without related symptoms does not typically need sleep testing. Of course, there are exceptions. No list can include all possible scenarios.

If you do have obstructive sleep apnea, it should be treated if:

1.       The sleep apnea is moderate to severe (more than 15 episodes of stopping breathing, or a 30% decrease in breathing with a 4% drop in blood oxygen) per hour of sleep

2.       The sleep apnea is mild (5-15 episodes per hour of sleep) with any of the 10 symptoms given above.

Otherwise, in the absence of related symptoms, mild obstructive sleep apnea does not typically require treatment. Again, of course, there are exceptions. There may be other conceivable situations where mild sleep apnea should be treated.