Management of the hospitalized patient with sleep disordered breathing

Sleep disordered breathing (SDB) frequently comes to medical attention for the first time when patients are hospitalized for diagnosis and treatment of an associated condition (eg, poorly controlled hypertension, myocardial infarction, congestive heart failure, stroke, or problems related to management of diabetes mellitus). Diagnosis of SDB is generally performed in a specialized facility, which is often inconvenient and expensive for the hospitalized patient. Expectant perioperative management of patients with sleep apnea is critical, particularly if they are previously undiagnosed. An ideal diagnostic strategy for these patients has not been defined. Continuous positive airway pressure (CPAP) is the mainstay of treatment of patients with sleep apnea. Unfortunately, it is often difficult for very ill patients to tolerate CPAP, unless it is administered with a high level of expertise.