Sleep apnea diagnosis and treatment in adults

Status: Decision completed

Policy context

Concerns about efficacy, effectiveness and safety regarding treatments for Obstructive Sleep Apnea (OSA). Important questions remain regarding diagnosis of OSA; the linkage between OSA and other conditions and/or risks; whether intervention reduces negative outcomes; whether treatments such as CPAP and surgical procedures should be used as (1) preventive; (2) treatment for established conditions; or (3) avoidance of bad outcomes for established disease; effectiveness of interventions.

Primary criteria ranking

  • Safety = Medium
  • Efficacy = High
  • Cost = Medium

Assessment timeline

  • Draft report published: January 12, 2012
  • Public comment period: January 12 to 30, 2012
  • Final report published: February 15, 2012
  • HTCC public meeting:  March 16, 2012


Sleep apnea is a common disorder that affects all ages. The American College of Chest Physicians estimates the prevalence of obstructive sleep apnea (OSA) in the United States to be between 5-10 percent and asserts that as many as one in four American adults could benefit from evaluation for OSA. The condition is characterized by periods of disturbed airflow patterns during sleep time, namely reduced airflow (hypopnea) or airflow cessation (apnea). It is postulated that both types of airflow disturbance have similar pathophysiology and bear the same clinical significance. OSA is by far the most common type of the condition; apneas and hypopneas of central and mixed central and obstructive etiology comprise the other forms. OSA has been associated with a variety of adverse clinical outcomes, such as mortality secondary to cardiovascular disease, decreased quality of life, cardiac disease and stroke, hypertension, and noninsulin-dependent diabetes, and other metabolic abnormalities. It also is associated with an increased likelihood for motor vehicle and other accidents.