NeuroVoices: Sunil Sharma, MD, on Implementing New Obstructive Sleep Apnea Guidelines in Hospital Settings

Obstructive sleep apnea and other forms of sleep-disordered breathing are highly prevalent yet frequently underrecognized among hospitalized patients, particularly those with cardiovascular and high‑risk comorbidities. Undiagnosed sleep apnea in this setting has been associated with increased hospital readmissions, higher mortality, greater emergency department utilization, and prolonged length of stay. As awareness grows that sleep is a key driver of cardiovascular risk, there is increasing emphasis on identifying and managing sleep-disordered breathing during hospitalization rather than relying exclusively on outpatient detection.

Sleep expert Sunil Sharma, MD, recently presented a talk on sleep apnea among hospitalized patients at the 2026 SLEEP Annual Meeting, held June 14-17 in Baltimore, Maryland. His presentation focused on new, comprehensive evidence-based guidelines from the American Academy of Sleep Medicine that outline a structured framework for screening hospitalized patients for sleep-disordered breathing.^1,2 Overall, these recommendations aim to shift the trajectory of outcomes for a vulnerable inpatient population by embedding sleep assessment and management into routine hospital practice.

In a new iteration of NeuroVoices, Sharma, section chief in the Division of Pulmonary Critical Care and Sleep Medicine at West Virginia University School of Medicine, discussed the high burden and clinical consequences of undiagnosed sleep apnea among hospitalized patients. He highlighted the guidelines’ practical framework for identifying at‑risk patients, initiating appropriate treatment in the hospital, and executing a robust transition-of-care plan to ambulatory sleep services. Sharma also addressed ongoing implementation challenges, including adapting the framework to hospitals of varying sizes and resources.

NeurologyLive: Can you provide an overview of your presentation at SLEEP 2026 and how it addresses sleep apnea in hospitalized patients?

Sunil Sharma, MD: The overarching theme of our symposium is that there is a high prevalence of sleep apnea in hospitalized patients, and an alarming number of those patients go undiagnosed, which has significant real-time consequences. Hospitals have a very enriched population of cardiovascular or high-risk patients, so by default there's a lot of burden of sleep apnea, most of it going unnoticed. Studies have shown that these patients remain undiagnosed, they have increased readmission risks, increased mortality, increased emergency room visits, and increased length of stay in the hospital. When the length of stay worsens, it impacts your throughput.

We want to bring this awareness to the bigger sleep community, and through the guidelines, which are very comprehensive and eloquently lay the framework on how to address this in order to change the trajectory of the outcome of these patients, that's the bottom line of that. Now, sleep is a driver of a lot of these cardiovascular implications, and unless we recognize that and fix it, those comorbidities will continue to worsen over time. What happens is when many of these patients are admitted to the hospitals, they never get diagnosed with sleep-disordered breathing, and the driver, which is causing these readmissions, never goes away. So, you treat them with Lasix and other medications, but the real reason why they are getting aggravated is not addressed.

We want to highlight to the sleep community that it is very important to screen these patients at the time of admission to the hospital. Then it becomes important to decide whether they even need treatment in the hospital, so just screening itself is not enough. Patients who are at high risk for sleep-disordered breathing are at a high risk for complications in the hospitals too. Studies have shown that they have bad outcomes in the hospitals, so we intervene, we screen them, we find out they had it, and start treatment for it. You can reduce the number of complications in the hospital, and of course, reduce the length of stay.

The other aspect is the long term where I was talking about that, that can impact mortality, increase deaths, readmissions later on, and that's a very important aspect, which the guidelines stress. All your hard work can get lost if you don't have a robust transition of care plan, and that's where most of the problem comes in. So, the guidelines very succinctly point out that the handoff has to be such that these patients, when they go out, continue to be taken care of their sleep needs. Studies, as noted in the guidelines, have shown that if you do that they have reduced hospital readmissions, their mortality improves overall. It's a very important intervention that has come to light.

Unfortunately, this has been a blind spot of sleep medicine because we have been practicing sleep medicine as an ambulatory specialty most of the time, and this was completely skipped until this data started coming up. In 2020, the American Academy of Sleep Medicine commissioned a task force to look at this data and come up with guidelines. This is basically the result of all the literature that was reviewed during the task force meeting over the last few years and has been presented at this conference.

What are the main takeaways from these new evidence-based guidelines for sleep clinicians managing sleep-disordered breathing in the hospital setting?

I think the sleep physicians need to be aware that hospitals are the watering hole for both cardiovascular diseases and sleep-disordered breathing. Hospital patients are not a barrier but an opportunity to make a difference in their outcome. The key message is, how do you do it? This is where the guidelines come into place, which lay out a very succinct framework on how do you screen, take care of their patients in the hospital, and then hand off into ambulatory service. I think if the physicians can take these two points to the heart, I think that would start changing the entire flavor and the outcome of hospital patients.

What key unanswered questions and implementation challenges should clinicians keep in mind, particularly around different hospital settings and resources?

In my opinion, it is still a nascent science, and a lot needs to be found out about it. It was very shocking that so many patients were going undiscovered, and that intervention would be helping that. But from our perspective, we haven't figured out a framework which will fit all types of hospitals. For example, all of these studies were done in large academic centers, and different hospitals throughout the country have different resources, sizes. Then, how are they going to adapt? That's a major challenge for us, is how the different hospitals with different sizes and different resources will be able to not only adapt to this framework but also maintain the spirit of the guidelines. I think that's a constant effort that we are continuing to work on.

I think the second challenge is that despite having these programs, even in the academic centers, we still find that the weakest link in the chain is the transition. As much as we have figured it out, as much as the academic hospitals are working towards it, it still remains that the weakest point is the transition of care from the hospital to ambulatory medicine. I think if the physicians can keep these two things in mind, I think they would be able to succinctly go about navigating the framework and successfully implementing this program in the hospital.

Transcript edited for clarity. Click here for more coverage of SLEEP 2026.

REFERENCES
1. 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
2. Sharma S. Breathing Easy in the Hospital: Applying the New Evidence-Based Guideline. Presented at: 2026 SLEEP Annual Meeting; June 14-17; Baltimore, Maryland.