AASM releases new guidelines for management of OSA in hospitals

DARIEN, Ill. - In a new clinical practice guideline, the American Academy of Sleep Medicine (AASM) for the first time is providing 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, the AASM says. The guidelines 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  

Previously published data show that sleep-disordered breathing is associated with a 17% increased length of stay for nonsurgical, hospitalized patients, and 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.” 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.