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Sleep disorders in hospitalized adults: Evaluation and management

Dennis Auckley, MD
Section Editors
Ruth Benca, MD, PhD
Nancy Collop, MD
Deputy Editor
April F Eichler, MD, MPH


Sleep-related breathing disorders such as obstructive sleep apnea (OSA) and central sleep apnea (CSA) occur with increased frequency in certain inpatient populations and may be associated with worse short-term outcomes. OSA is also common in the general population, is often undiagnosed, and may be first recognized in the inpatient setting. These and other primary sleep disorders are important to recognize, as acute illness and other aspects of hospital admission may aggravate chronic symptoms or bring to light previously unrecognized symptoms.

This review will discuss the evaluation, consequences, and management of sleep disorders in hospitalized adults. An approach to poor sleep in the inpatient setting is reviewed separately. (See "Poor sleep in the hospital: Contributing factors and interventions".)


Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder, and most patients are undiagnosed. OSA may be first recognized in the inpatient setting, when sleep is directly observed and continuous hemodynamic and respiratory monitoring reveal breathing pauses and intermittent hypoxemia.

Prevalence — The estimated prevalence of OSA in the general population is approximately 15 percent in males and 5 percent in females [1]. OSA is significantly under-recognized in the outpatient setting [2,3], and most patients are undiagnosed [4]. (See "Overview of obstructive sleep apnea in adults", section on 'Epidemiology'.)

The prevalence of OSA in the general inpatient population has not been well studied but it is likely to be even higher than in the general population, as the inpatient population is enriched with comorbid conditions associated with OSA, such as obesity, diabetes, hypertension, and cardiovascular diseases [5,6]. Studies using screening questionnaires have found that 40 percent of inpatients ≥50 years old and 87 percent of inpatients with a body mass index (BMI) ≥30 kg/m2 score as high risk for OSA [7,8].

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Literature review current through: Nov 2017. | This topic last updated: May 18, 2016.
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