Inpatient Sleep Consultation

Part A Sleep disordered breathing (SDB) is increasingly recognized as a presenting or major comorbid diagnosis in hospitalized patients. However, there is no clear guidance on indications for inpatient sleep medicine consultation, SDB evaluation in inpatient versus outpatient setting, or optimal timing and type of positive airway pressure (PAP) treatment to be provided. Figure 8.1 gives an algorithmic approach to inpatient sleep medicine. Variations in the availability of diagnostic tests such as inpatient sleep test and pulmonary function test, and insurance coverage of PAP devices upon discharge are potential factors that limit standardized recommendations. Observational studies show that SDB is associated with increased risk for in-hospital and post-discharge adverse outcomes and compliance with PAP therapy decreases this risk. In particular, specific subgroups of patients may benefit from intervention during hospitalization, including (1) chronic respiratory failure due to severe lung disease such as chronic obstructive pulmonary disease, (2) chronic respiratory failure due to neuromuscular or thoracic cage disease, and (3) SDB in heart failure or postoperative individuals. However, the benefits of inpatient consultation on patients’ outcomes are yet to be determined.