The American Academy of Sleep Medicine has released its first clinical practice guideline focused on identifying and managing obstructive sleep apnea in medically hospitalized adults, shifting attention beyond the traditional outpatient setting.
Key takeaways:
- The guideline is the first from AASM to address screening, treatment, and care coordination for obstructive sleep apnea during medical hospitalizations.
- All four recommendations are conditional, underscoring limited evidence and the need for clinician judgment based on patient values and institutional resources.
- The guidance supports screening high-risk inpatients, using PAP therapy for untreated moderate to severe OSA, involving sleep medicine consultation, and planning discharge to reduce loss to follow-up.
- Patients with an established diagnosis of sleep-disordered breathing should generally continue their existing therapy while hospitalized unless contraindicated.
- The document highlights evidence linking sleep-disordered breathing to longer hospital stays and substantially higher hospitalization costs.
- AASM emphasizes oversight by board-certified sleep physicians and notes that telehealth may help extend sleep medicine consultation in resource-limited hospitals.
A new clinical practice guideline is the first from the American Academy of Sleep Medicine (AASM) to provide recommendations for the management of obstructive sleep apnea in medically hospitalized adults.
Previously published data show that sleep-disordered breathing is associated with a 17% increased length of stay for nonsurgical, hospitalized patients, and it is associated with a 67% increase in hospitalization costs.
“The existing clinical paradigm for the diagnosis, management and treatment of obstructive sleep apnea has focused on the outpatient arena, so guidance for inpatients has been lacking,” says lead author Reena Mehra, MD, MS, chair of the AASM task force that developed the guideline and head of the division of pulmonary, critical care and sleep medicine at University of Washington Medicine in Seattle, in a release. “While there will be marked variations in hospital and institutional resources to screen, diagnose and treat sleep apnea, these recommendations serve as a guide to move the field forward in prioritizing systematic approaches to manage sleep apnea in the inpatient setting.”
All four clinical recommendations in the guideline are designated as “conditional,” meaning that they reflect a lower degree of certainty and require the clinician to use clinical judgment while considering the patient’s values and preferences to determine the best course of action. These recommendations support:
- Inpatient screening of obstructive sleep apnea in high-risk patients as part of an integrated evaluation and management pathway,
- Use of PAP therapy in those with moderate to severe sleep apnea who are currently untreated,
- Sleep medicine consultation for those with increased risk of sleep apnea or established sleep apnea, and
- Discharge plans for management of sleep apnea with a goal to minimize loss to follow-up.
The guideline also emphasizes that adults with an established diagnosis of sleep-disordered breathing should continue their existing treatment while in the hospital, unless contraindicated.
While the authors acknowledged that the availability of hospital-based sleep medicine consultations will vary by location, they indicated that the preference is to have oversight by a board-certified sleep medicine physician and involvement of the sleep team at an AASM-accredited sleep center. This involvement can include consultations facilitated using telehealth tools.
To develop the guideline, the AASM commissioned a task force of sleep medicine physicians with expertise in the management of hospitalized adults with sleep apnea. They crafted clinical practice recommendations based on a systematic review of the literature and an assessment of the evidence according to the GRADE process, taking into consideration the certainty of evidence, beneficial and harmful effects, patient values and preferences, and resource use. The draft guideline was posted for public comment, and the AASM board of directors approved the final recommendations.
This guideline was endorsed by the Alliance of Sleep Apnea Partners, American Association for Respiratory Care, American Association of Sleep Technologists, American Society for Metabolic and Bariatric Surgery, American Thoracic Society, Project Sleep, Society of Anesthesia and Sleep Medicine, and the Wellness, Sleep, and Circadian Network. The American Academy of Otolaryngology – Head and Neck Surgery and its foundation and the American Society of Anesthesiologists affirmed the value of this guideline.
