Managing Obstructive Sleep Apnea in Hospital Settings: Key Takeaways From the New AASM Guideline

Prior research has shown that sleep-disordered breathing is linked to a 17% longer hospital length of stay for nonsurgical patients and a 67% increase in hospitalization costs.¹ Obstructive sleep apnea (OSA), a chronic condition characterized by repeated upper airway collapse during sleep, affects an estimated 54 million adults in the United States.² Positive airway pressure (PAP) therapy, delivered via a mask to maintain airway patency, is considered the most common treatment for OSA, helping to reduce associated sleep breathing complications.

Recently, the American Academy of Sleep Medicine (AASM) published a new guideline in the Journal of Clinical Sleep Medicine that provides clinical recommendations for the management of OSA in medically hospitalized adults.^3,4 The 4 main recommendations in the guideline focus on screening high-risk inpatients, initiating PAP therapy in untreated moderate-to-severe OSA, involving sleep medicine consultations when indicated, and planning discharge to ensure continuity of care. These new recommendations were developed by an AASM task force through systematic literature review, assessment of evidence using the GRADE framework, and public comment.

Co-author of the guideline Karin Johnson, MD, FAAN, FAASM, professor of neurology at UMass Chan School of Medicine, recently spoke with NeurologyLive^® to highlight its implications for clinical practice. In the interview, Johnson highlighted the key recommendations for inpatient evaluation, treatment, and coordination of outpatient follow-up. She emphasized that the conditional nature of the guidance requires clinicians to consider patient preferences and institutional resources. Above all, Johnson called for more research on care pathways, implementation, and outcomes across diverse patient populations.

NeurologyLive: What are the most important takeaways from this new guideline for the evaluation and management of OSA in hospitalized patients?

Karin Johnson, MD, FAAN, FAASM: OSA is very common in patients admitted to the hospital, especially with conditions like stroke, heart failure, pneumonia and many of the other most common causes of admission. It is also often underdiagnosed and under treated in the clinical setting. Treating OSA during and after hospitalizations, especially in patients with high-risk comorbidities like stroke and heart failure, can help improve recovery and prevent recurrent events and readmissions.

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 hospital stay and 67% increased costs.

How should clinicians apply this guideline in practice, and could you explain the different approaches to inpatient sleep medicine?

Inpatient sleep medicine can come in many different forms. This can include, but is not limited to, screening, diagnostic testing, inpatient treatment or just helping to facilitate the transition to more rapid out-patient follow-up which is common because of the long wait times to get in to see a sleep medicine specialist or receive out-patient sleep testing.

Although the research available pointed to the benefits of inpatient sleep medicine and the recommendations made by the task force, due to the limited number and size of studies, the certainty of evidence was low to very low. This 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. We hope this guideline may help change payor policies that will support inpatient sleep medicine and spur further research.

What gaps in evidence still exist regarding OSA management in hospitalized patients?

We need more studies both on the impact of initiating care pathways in the hospital and translational research for how best to implement care and ensure smooth transitions of care to the outpatient setting. For example, the Sleep Smart study is a large NIH study that is researching starting continuous PAP treatment immediately after stroke and looking at both recovery and recurrence outcomes. If this is a positive study, it aims to revolutionize care pathways for OSA in stroke patients. We need more studies in patients with other common reasons for hospitalization like asthma.

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 to others, therefore representing an opportunity to augment this presence of expertise. There will be differences in hospital-based policies, such as 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.

Transcript edited for clarity. Click here to view more of our coverage on sleep disorders.

REFERENCES
1. May AM. Sleep-disordered Breathing and Inpatient Outcomes in Nonsurgical Patients: Analysis of the Nationwide Inpatient Cohort. Ann Am Thorac Soc. 2023;20(12):1784-1790. doi:10.1513/AnnalsATS.202305-469OC
2. Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7(8):687-698. doi:10.1016/S2213-2600(19)30198-5
3. Mehra R, Auckley DH, Johnson KG, et al. Evaluation and management of obstructive sleep apnea in adults hospitalized for medical care: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2025;21(12):2193-2203. doi:10.5664/jcsm.11864
4. New guideline establishes clinical recommendations for sleep apnea in hospitalized adults. News release. American Academy of Sleep Medicine. November 7, 2025. Accessed March 19, 2026. https://aasm.org/new-guideline-establishes-clinical-recommendations-for-sleep-apnea-in-hospitalized-adults/