Note: This section provides a schematic overview of select OSA screening strategies. OSA must be confirmed by a physician or sleep specialist.

OSA Screening Strategies

OSA

Existing Medical Conditions

Individuals with diabetes, hypertension, cardiac arhythmmia, heart disease, obesity, heart-failure, stroke; and women with PCOS are significantly more likely to have OSA or some other form of SDB.

OSA

Older Versus Younger

Due to a number of factors that include the penchant for weight-gain and reductions in the stiffness of the upper-airway musculature, individuals over 50 (and post-menopausal women) are at increased risk.

OSA

Men Versus Women

Males are significantly more likely to have OSA, however post-menopausal women approach the rate of men overall and women with PCOS are at significantly higher risk for OSA than women in general.

OSA

Signs & Symptoms

Aggressive snoring is a major indicator for upper-airway resistance and OSA. Body mass index (BMI) is also a good indicator but for some populations neck circumference is a better indicator that abdominal fat.

Popular OSA Screeners

Relatively concise OSA screening questionnaires can be found on an increasing number of websites (including ours). These include the popular STOP-Bang questionnaire, the Berlin questionnaire and proprietary combinations (such as AASM's OSA risk assessment checklist) that incorporate OSA risks such as loud snoring, age, gender, witnessed apneas, neck size and the prevalence of comorbid conditions that are highly associated with OSA, including drug-resistant hypertension (requiring two or more medications), type 2 diabetes, heart failure, stroke, and morbid obesity, amongst others. The need to include comorbid conditions is based upon data that demonstrate the cross association between these clinical conditions or symptoms and OSA. These associations are further strengthened by a large and growing body of clinical studies that demonstrate the actual causal physiological mechanisms that link OSA to cardiovascular and metabolic disorders, as we present in the OSA Impacts link below. The STOP-Bang and Berlin questionnaires have gone through a number of validated clinical studies to determine their sensitivity and selectivity, which is roughly the balance between their ability to capture individuals that are likely to have OSA without over estimating that candidate pool with individuals that do not have OSA. Additional screening strategies focus on self-reported sleepiness, like the Epworth Sleepiness Scale (ESS).

Despite the validation of these nearly ubiquitous OSA screening questionnaires, additional points need to be emphasized.
We reference also in the OSA Treatmentlink the fact that 41% of respondents to a recent AASM survey were actually found to be diagnosed with severe OSA and 43% with moderate OSA even though the initial physician's assessment had predicted through screening that 62% were mild, 30% were moderate, and only 8% were projected to be severe (n=506). This underestimation is noteworthy because both patients and physicians are more reluctant to engage in treatment when either screening or diagnostics characterize the severity as mild or even moderate. Secondly, self-reports of sleepiness and other self monitoring metrics notoriously underestimate the potential for sleep disorders and the behavioral impacts from poor sleep (including safety risks). Thirdly, sleep questionnaires often query for "sleepiness", whereas it has been found that women often report 'fatigue' instead of sleepiness. Lastly, OSA was initially associated with a higher probability of risk for the male gender, but additional studies have revealed that certain stages of life increase the odds of developing OSA for women. Post-menopausal women begin to approach the same risk as men,and women with specific conditions such as obesity and polycystic ovarian syndrome (PCOS) are at increased risk for OSA relative to other women. (See Sleep Disorders & Women link).

Pregnant women are at increased risk for SDB, with the additional burden of increased risk for premature deliveries and other serious medical risks. These appear to be associated with a combination of obesity, preeclampsia, SDB and gestational diabetes, all of which may intertwine in a causal vicious cycle.

The screening sections of our education system are not designed to compete with or replace clinically validated screeners that are widely utilized, but rather, to provide additional context and interest in sleep optimization through the process of screening.

>80%

Still Untreated

Over 80% of the population that is thought to have OSA is still untreated.

~80%

Obesity & OSA

About 80% of morbidly obese men also have OSA though most are untreated.

~80%

Truck Drivers

Nearly 80% of truck drivers are overweight with nearly 50% considered obese.

~80%

Resistant High BP

Nearly 80% of Drug-resistant hypertensives with 2 BP meds have OSA.

OSA Diagnostics

The diagnostic confirmation of OSA requires either a home sleep apnea test (HSAT) or an overnight in-lab polysmonography test (PSG). The trend is increasingly toward home testing solutions, however, a traditional overnight fully-attended PSG is still required for patients with select conditions, including but not limited to: congestive heart failure (CHF), certain neuromuscular diseases, hypoventilation disorders, COPD, and patients currently on oxygen therapy or CPAP therapy.

There are a number of national home apnea test or device providers including: WatchPAT, Novasom, ResMed, Respironics and others. Ask your physician about the diagnostic source that they are the most comfortable with following screening.The current healthcare structure seeks to utilize primary care physicians as the gateway to treatment of OSA, including screening, diagnostics and oversight of treatment compliance. Primary care physicians are increasingly aware of the adverse cardiometabolic and psychological impacts associated with common sleep disorders such as OSA and poor sleep quality, but PCP's are not trained specifically in sleep disorders. If you also require a sleep specialist associated with a sleep center, you can use the sleep center locator from the American Academy of Sleep Medicine (AASM): locator.

Educate Yourself.

Although Nourish Sleep is a non-clinical entity, we do not operate outside of a responsible care pathway. Nourish Sleep screening does not constitute confirmation of a sleep disorder or lack thereof. Only a face-to-face clinical evaluation with a clinician or board certified sleep physician can affirm the necessity for further diagnostics or treatment. Our role is to educate you and provide you a rigorous, but highly tailored and comprehensive understanding of your specific sleep quality. Although we work collaboratively with a diverse array of clinical and educational resources to fulfill that mission, Tri-Nourish Inc and Nourish Sleep constitute non-clinical entities offering non-clinical services. Our goal is to assist your sleep quality in a pre-pathological (preventative) approach that takes into consideration domains that impact health and wellbeing before they transition into common sleep, mental or physiological disorders. Poor sleep quality radically impacts productivity, performance, health, emotional resilience, and safety— well before the sleep disorder threshold has been breached.