December 16, 2025
4 min read
Key takeaways:
- An American Academy of Sleep Medicine task force established four graded recommendations for managing OSA in hospitalized adults.
- Each recommendation is deemed “conditional.”
Compared with the outpatient setting, there is a lack of guidance on diagnosing, managing and treating obstructive sleep apnea in the inpatient setting, Reena Mehra, MD, MS, FAASM, said in a press release.
With this in mind, Mehra, head of the division of pulmonary, critical care and sleep medicine at the University of Washington Medicine, and 11 clinicians collaborated to write an American Academy of Sleep Medicine (AASM) clinical practice guideline on evaluating and managing OSA in hospitalized adults. This guideline is published in the Journal of Clinical Sleep Medicine.
Through a systematic review of 27 studies related to this topic, the task force established four graded recommendations and a good practice statement.
The recommendations discuss OSA screening, PAP treatment, sleep medicine consultation and a discharge management plan. Notably, each recommendation is deemed “conditional,” which means it “requires that the clinician use clinical knowledge and experience and strongly consider the patient’s values and preferences to determine the best course of action,” according to the guideline.
Healio spoke with Mehra, chair of the AASM task force, to learn more about the four recommendations and how clinicians can implement them into practice.
Healio: Why is there a need for recommendations on how to evaluate and manage OSA in hospitalized adults?
Mehra: The guideline was developed to, for the first time, provide guidance to clinicians in terms of the approach to evaluation and management in inpatient adults with established or suspected sleep apnea. The high prevalence of sleep apnea and some evidence supporting the association of sleep apnea with worse inpatient clinical outcomes and increased readmissions provides a strong rationale for the need for such guidance. Sleep apnea is also associated with a 17% increased length of stay per whole day increment and 67% increased costs.
Healio: The first clinical recommendation is focused on in-hospital screening for OSA in adults at high risk for the condition. What are the potential benefits of conducting this in-hospital screening compared with no screening?
Mehra: The initial screening helps ensure that patients are receiving the proper level of care. If a patient has established sleep-disordered breathing (irrespective of subtype) and is on treatment, then for the same reasons the patient is on treatment as outpatient (ie, to improve related symptoms and quality of life and to mitigate adverse clinical outcomes), the patient should continue this therapy in the inpatient setting. There are estimates as low as 5.8% of continuation of existing sleep apnea treatment with PAP therapy in the inpatient setting.
Healio: What was the reasoning behind suggesting use of inpatient treatment with PAP in adults diagnosed with OSA not on treatment?
Mehra: The rationale is to ensure that patients receive an adequate level of care for their condition, especially in a clinical setting where they may be at higher risk for other secondary illnesses. PAP may improve clinical outcomes and hospital-specific outcomes.
Healio: Why is offering a sleep medicine consultation important in hospitalized adults diagnosed with or at risk for OSA? If there are no sleep specialists available at a hospital, how can clinicians work around this?
Mehra: Observational data from a study indicate a high value of the downstream benefits of inpatient consultation including identification of sleep apnea. Indirect evidence supports that the diagnosis of OSA may also lead to improvement in clinical outcomes, particularly in high-risk populations such as those with cardiopulmonary or neurologic disease. To implement the other conditional recommendations, a sleep medicine consultation would provide the necessary expertise and guidance of care for inpatients with those at-risk or with established OSA diagnosis.
If there are no sleep specialists, other health care professionals such as APPs, respiratory therapists, etc, could be enlisted to provide support for a consultation service.
The guideline provides a start in increasing awareness and hopefully the impetus for more attention to be directed to sleep apnea in the inpatient setting.
Healio: What is involved in a discharge management plan for adults at risk for OSA or diagnosed with OSA?
Mehra: As a conditional recommendation, this guideline will vary from patient to patient. Discharge management may include ordering post-discharge testing or sleep medicine evaluation, particularly if the patient is at-risk or undiagnosed. Additionally, considering inpatient sleep testing prior to discharge and/or telehealth medicine may be an option to reduce barriers to care. Providers should also discuss care coordination with patients and their caregivers to ensure appropriate follow-up once that patient returns home.
Healio: What should clinicians who work in the inpatient setting take away from this clinical guideline? How can they start putting it into practice?
Mehra: Given that the certainty of evidence was low to very low, although some evidence was available for specific outcome improvement, there was an element of risk for bias to some of the studies that precluded us from making a stronger recommendation.Therefore, these conditional recommendations require that the clinicians use their clinical knowledge and experience and strongly consider the individual patient’s values and preferences to determine the best course of action.
Healio: Moving forward, what other guidelines are needed in the OSA space?
Mehra: There are several existing guidelines focused on OSA diagnostics and management that serve as useful resources for the clinician. As the treatment paradigm is changing with newer options for sleep apnea treatment, these guidelines will be updated and there are opportunities to consider additional areas such as sex-specific differences in diagnostics and treatment of sleep apnea.
We recognize that there will be variability in personnel and resources across institutions, which may pose challenges with the implementation of the conditional recommendations. The background experience and expertise in the nuances of sleep apnea management may be stronger in some institutions compared with others, therefore representing an opportunity to augment this presence of expertise. There will be differences in hospital-based policies, eg, clinical engineering in terms of allowing use of home PAP devices or inpatient devices and also potential PAP device supply issues. Processes to implement the screening, treatment and discharge planning are also needed. Our intention is to raise clinical awareness about the importance of screening for and treating individuals in an inpatient setting for OSA.
For more information:
Reena Mehra, MD, MS, FAASM, can be reached at mehrar@uw.edu.
Sources/Disclosures
Source:
Healio Interviews
References:
Disclosures:
Mehra reports receiving funds to her institution from the NIH (R21 HL170206) and the Women’s Alzheimer’s Movement for research; receiving consultancy funds from Amgen, Apnimed, Eli Lilly and Mineralys; receiving funds from Pri-Med and Haymarket Media; and receiving royalties from UpToDate.
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