Undiagnosed Sleep-Disordered Breathing Leads to Avoidable Complications, Cost: Sunil Sharma, MD

Hospitalized patients face a substantial but underrecognized burden of sleep apnea, with serious consequences for both short- and long-term outcomes, according to Sunil Sharma, MD, chief and professor of pulmonary/critical care and sleep medicine at West Virginia University School of Medicine, at the American Academy of Sleep Medicine and Sleep Research Society Annual Meeting. Although hospitals care for a disproportionately high-risk cardiovascular population, an alarming number of patients with sleep-disordered breathing remain undiagnosed during admission, leading to avoidable complications and costs.

Sharma explained that untreated sleep apnea in the inpatient setting is closely linked to increased readmissions, higher mortality, more frequent emergency department visits, and longer lengths of stay. Because hospital populations are enriched with individuals who have heart failure, arrhythmias, and other cardiovascular comorbidities, the failure to recognize and treat sleep-disordered breathing means that a key driver of decompensation is left unaddressed. Clinicians may manage fluid status and prescribe medications like diuretics, but if the underlying sleep disorder is missed, the cycle of deterioration, readmission, and worsening comorbidities continues.

New guidelines from the American Academy of Sleep Medicine (AASM) aim to close this gap. Commissioned in 2020, an AASM task force reviewed the emerging evidence base and developed comprehensive recommendations for screening, inpatient management, and postdischarge care of hospitalized patients at risk for sleep apnea. The guidelines emphasize that screening alone is insufficient: patients identified as high risk may also require initiation of therapy during hospitalization to reduce immediate complications and length of stay.

Equally critical, the guidelines highlight the importance of a robust transition-of-care plan. Without a deliberate handoff to outpatient sleep services, the benefits of inpatient identification and treatment can be quickly lost. Studies summarized in the guidelines show that when patients’ sleep needs are actively managed after discharge, hospital readmissions decline and mortality improves.

Sharma also noted that inpatient sleep medicine has historically been a “blind spot” because the field evolved primarily as an ambulatory specialty. However, accumulating data now underscore that recognizing and treating sleep-disordered breathing during hospitalization is a crucial intervention for improving outcomes in high-risk patientsn with cardiovascular complications and for reducing the overall burden on health systems.