DARIEN, IL – A new clinical practice guideline is the first from the American Academy of Sleep Medicine to provide recommendations for the management of obstructive sleep apnea in medically hospitalized adults.
Available online as an accepted paper in the Journal of Clinical Sleep Medicine, the guideline fills an existing gap in clinical practice and addresses an area of growing concern. 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,” said lead author Dr. Reena Mehra, 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. “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.”
It is estimated that 54 million adults in the U.S. have obstructive sleep apnea, a chronic disease that involves repeated collapse of the upper airway during sleep. Sleep apnea is commonly treated with positive airway pressure (PAP) therapy, which uses mild levels of air pressure, provided through a mask, to keep the airway open during sleep.
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
- 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. In addition to PAP therapy, treatments for sleep apnea include oral appliance therapy and upper airway stimulation therapy.
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.
The co-authors of the guideline are Dr. Dennis Auckley, Dr. Karin Johnson, Dr. Martha Billings, Gerard Carandang, Dr. Yngve Falck-Ytter, Dr. Rami Khayat, Dr. Reem Mustafa, Dr. Cinthya Pena-Orbea, Dr. Ashima Sahni, Dr. Sunil Sharma, and Dr. Susheel Patil.
View more AASM clinical practice guidelines and learn more about the guideline development process.
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To arrange an interview with Dr. Mehra or an AASM spokesperson, please contact the AASM at media@aasm.org. Accepted papers, which are published online prior to their final inclusion in an issue of the journal, are not embargoed. The guideline was posted as an accepted paper on Aug. 21 and is scheduled to be published in the December issue of the Journal of Clinical Sleep Medicine.
About the American Academy of Sleep Medicine
Established in 1975, the AASM is a medical association that advances sleep care and enhances sleep health to improve lives. The AASM membership includes more than 9,500 physicians, scientists, and other health care professionals who help people who have sleep disorders. The AASM also accredits 2,300 sleep centers that are providing the highest quality of sleep care across the country.
