SLEEP 2026 | AASM guidelines for the management of sleep apnea in hospitalized patients

So the ASM put out a new guideline for the treatment of obstructive sleep apnea in hospitalized patients. They started with a good practice recommendation that if a patient is already using a treatment for sleep apnea at home to continue it while in the hospital and that’s regardless of whether it’s CPAP or a mandibular advancement device or hypoglossal nerve stimulator. There may be some patients where it’s not appropriate to continue treatment. If they’re in there with respiratory failure, they might need a different level of treatment. If they’ve had facial trauma, they might not be able to continue with CPAP. But all other things considered, recognizing that they do have sleep apnea, it’s very important. You know, a lot of patients aren’t asked about it, whether that is a treatment they have at home. So making sure it’s sort of part of, you know, the med rec to also do that sleep apnea treatment rec is important. And use of EHR might be able to help screen better for recognizing those people. And then the other recommendations, they’re all conditional low evidence recommendations. We still need a lot more research in this area, but we did find positive studies to really support the use of sleep medicine consultations in the hospital, led by a sleep medicine physician to really help coordinate care. And this might be as simple as connecting people into outpatient care so that they can start on treatment timely after the hospital, but if able, based on the resources, to get people being treated and diagnosed. So one recommendation is for screening of high-risk patients. You may think especially about stroke patients, heart failure patients, that’s the two areas that have the most data that is out there, that if we can do either screening tools or more objective tools like high-resolution pulse ox and you can then if you recognize that they potentially have sleep apnea you can either go on to further diagnostics potentially in the hospital or again connecting them outpatient to rapid diagnostics or you might go straight to empiric treatment in the hospital. So there’s actually data that suggests lower rapid response rates in people that are treated with CPAP in the hospital versus not. So that was some of the recommendations of if you either have newly diagnosed or diagnosed but untreated sleep apnea to think about getting them on treatment during their hospitalization. And then again there is potential data to do actual diagnostic testing if possible. Unfortunately that’s often not paid for at this point so that often limits the number of hospitals that are doing it but thinking about whether using portable you know home sleep testing devices can be used in the hospital and there’s some data that supports even in heart failure patients we don’t necessarily go you know for home testing that that might be useful, there’s been a lot of data in the stroke population as well. And so really important to think about whether you can do treatment diagnostics if you don’t have the resources to do it, to use that consult and use those resources to get people sort of connected for that treatment, not only for secondary prevention, but also especially in patients like stroke to help with recovery outcomes in a timely manner.

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