Inaugural clinical guideline for obstructive sleep apnea

Dr. Reena Mehra, professor and head (Pulmonary, Critical Care and Sleep Medicine) chaired the task force and is lead author of the inaugural American Academy of Sleep Medicine clinical practice guideline addressing the topic of inpatient sleep medicine and obstructive sleep apnea (OSA) in medically hospitalized adults. Department of Medicine co-author is Dr. Martha Billings, who leads the inpatient sleep medicine program at Harborview Medical Center.

The prevalence of moderate to severe OSA in medically hospitalized adults is estimated to be 25-77%, depending upon the population studied, and the majority are undiagnosed. Furthermore, OSA is associated with a 17% increased length of stay per whole day increment and 67% increased costs even after accounting for potential confounding factors.  

To date, the existing clinical paradigm for the diagnosis, management and treatment of OSA has focused on the outpatient arena. This guideline was developed to provide guidance regarding the evaluation and management of OSA in medically hospitalized adults, a setting that is increasingly being recognized as an opportunity to identify and manage OSA with the intent to improve clinical outcomes.

Recommendations

1. Incorporating OSA screening into the comprehensive inpatient care pathway.
2. Providing inpatient positive airway pressure (PAP) therapy for patients with a known diagnosis of moderate to severe OSA who are not yet on outpatient therapy, and continuing PAP therapy for those already receiving it as outpatients.
3. Offering inpatient sleep medicine consultations as resources allow.
4. Developing a peri-discharge management plan focused on OSA care.

"Recognizing and managing OSA in hospitalized patients is a critical step toward improving outcomes," said Mehra. "There are many opportunities for future investigation to better inform the benefits and value of approaches to diagnosis and management of sleep disordered breathing in the inpatient setting."