Bertrand de Silva, MD, FCCP, uncovers the importance of continuing treatment for sleep apnea in hospitalized patients to their recovery, length of hospital stay, and health outcomes.
by Bertrand de Silva, MD, FCCP
Sleep is an essential aspect of human well-being. Quality sleep promotes healing, cognitive function, mood stabilization, and overall health. In contrast, disruptions in sleep patterns can lead to a multitude of health issues, both physical and psychological. One such disruption is sleep apnea, a condition characterized by repeated interruptions in breathing during sleep. While sleep apnea is a concern in any setting, it becomes particularly critical in hospitalized patients. Addressing this issue can pave the way for quicker recovery, reduced hospital stay, and better patient outcomes.
In hospital setting, the presence of obstructive versus central and mixed sleep apnea may further complicate the presentation and recovery of patients, especially with strokes, heart failure, and pulmonary disease. This disease process which is not often recognized results in increased mortality and morbidity in the hospital setting with delayed discharge from the intensive care unit and readmissions to the intensive care unit as well as readmissions on the same diagnostic related group (DRG).
Why is Sleep Apnea a Concern for Hospitalized Patients?
- Compromised Healing Process: A good night’s sleep is critical for the body’s healing processes. For hospitalized patients, these restorative phases of sleep are vital. Sleep apnea, however, can disturb these phases, slowing down recovery.
- Cardiovascular Strain: Sleep apnea often leads to sudden drops in blood oxygen levels, which can strain the cardiovascular system, leading to conditions like hypertension, heart attacks, and strokes. In hospitalized patients, especially those with pre-existing heart conditions, this can be perilous.
- Impaired Cognitive Function: Sleep- deprived patients, due to untreated sleep apnea, may experience memory issues, mood changes, and decreased concentration, affecting their capacity to understand medical instructions and participate actively in their recovery.
- Increased Medication Sensitivity: Sleep apnea can alter a patient’s response to sedatives, pain medications, and anesthesia. This can lead to complications during surgical procedures or prolonged sedation periods.
- Higher Risk of Complications: Hospitalized patients with undiagnosed or untreated sleep apnea have a higher risk of postoperative complications. This includes respiratory failure, cardiac events, and longer stays in intensive care units.
- There is a higher incidence of sleep apnea in hospitalized patients, especially in the intensive care unit that masquerades as multiple comorbidi Recognition of this condition in the intensive care unit stay is essential in aiding early extubation and, if diagnosed prior to discharge, could result in discharge of the patient with the appropriate positive airways pressure equipment thereby reducing post hospitalization mortality morbidity and readmission under the same DRG
- Cerebrovascular accident exacerbates both central and obstructive sleep apnea and if identified early can lead to improved outcomes.
Identifying and Managing Sleep Apnea in the Hospital Setting
Hospital staff should prioritize identifying patients at risk of sleep apnea. A comprehensive medical history, physical examination, and if necessary, a hospital-based sleep study, can help in the diagnosis. Common signs include loud snoring, observed episodes of stopped breathing, abrupt awakenings followed by gasping, excessive daytime sleepiness, and difficulty concentrating. Witnessed apneas during procedures together with sudden episodes of tachycardia/bradycardia on monitored units are examples of easily assessed signs of obstructive and central sleep apnea.
Management approaches for hospitalized patients with sleep apnea include:
- Positional Therapy: Keeping the patient in a side-sleeping position can prevent the collapse of the airway, especially in OSA cases.
- Continuous Positive Airway Pressure (CPAP): This is a machine that delivers a steady stream of air through a mask, helping to keep the airways open. It’s the primary treatment for OSA.
- Adaptive Servo-Ventilation (ASV): This device is beneficial for central sleep apnea patients. It adjusts the amount of air supplied based on detected abnormalities.
- Medications: While drugs are not the primary treatment for sleep apnea, some can alleviate symptoms or treat underlying causes.
- Educating Hospital Staff: All hospital staff, from nurses to anesthesiologists, should be educated on the risks associated with sleep apnea. This can lead to more personalized patient care and a proactive approach to managing potential complications.
Conclusion
For hospitalized patients, the risks associated with untreated sleep apnea are magnified. Recognizing and addressing this condition can substantially improve patient outcomes. As medical professionals, prioritizing sleep health is not just about ensuring rest but about optimizing the very processes that enable healing, recovery, and overall wellness. Sleep apnea is not merely an inconvenience; in the hospital setting, it can be the difference between rapid recovery and severe complications. Every patient deserves comprehensive care, and addressing sleep health is a critical component.
Heart health is a big part of continuing treatment for sleep apnea in hospitalized patients. Read more about atrial fibrillation and OSA in this article by Dr. Alan D. Steljes here: https://dentalsleeppractice.com/atrial-fibrillation-and-osa/.
Bertrand de Silva, MD, FCCP, is a graduate of the St. Thomas Hospital Medical School, University of London, England 1986. He was awarded a Medical Research Council Scholarship as well as Medical Research Council Fellowship. He was also awarded a $2 million Research Grant by Burroughs Wellcome Foundation and became a Burroughs Wellcome Research Foundation Scholar. He completed his Internship at Kern Medical Center, Bakersfield and Internal Medicine training at USC County Hospital, Los Angeles and a Pulmonary, Critical Care and Sleep Fellowship at Cedars Sinai Hospital. He is board certified in all these fields. Dr. de Silva is currently a Staff Intensivist for Sound Physicians Intensivist Group at St. Bernadine’s Medical Center in San Bernardino, for Benchmark at Palomar Regional Medical Center in Escondido. He is the Medical Director of the Sleep Services at St Judes Fullerton, at Preferred Sleep Solutions in Fullerton. He serves as a national consultant to American Imaging Management, AIM Specialty Health (Anthem Subsidiary) in developing the National Sleep Apnea Treatment and Diagnosis Clinical Guidelines.