When should hospitalized patients be tested for breathing problems in sleep?

More than 10 per cent of adults suffer from moderate to severe breathing problems during sleep, but many don’t even know it. Sometimes the first person to notice the problem is a hospital staff member, when a patient stays overnight.

Should these patients be tested for sleep-disordered breathing (SBD) during their hospital stay, or should they be referred for testing in the community after discharge? This question is important because untreated SBD has been linked to higher rates of stroke and heart attack, as well as sedation complications, and longer hospital stays. 

A study led by Dr. Tetyana Kendzerska published in the Annals of the American Thoracic Society suggests a sleep study within a month of hospital discharge may be the better choice.

The team looked at administrative data on health-care resource use and survival one year after hospitalization among all Ontario adults between 2012 and 2018. They compared inpatients who had a sleep study (polysomnography) during their hospitalization, to inpatients who had a sleep study within a month of discharge, to similar inpatients who did not have a sleep study.

In this large population-based study, sleep studies done after hospital discharge were linked to better survival and lower health-care costs than those performed in hospital. While inpatient testing was associated with better survival than no testing, it required more health-care resources. These findings suggest that, for many patients with suspected SDB, delaying testing until after discharge may be a more efficient approach, though further prospective studies are needed.

“Our research suggests that in some patients, delaying a sleep study until after a patient is discharged may achieve similar or better outcomes at a lower cost,” said Dr. Kendzerska, a sleep physician and clinician scientist at The Ottawa Hospital and associate professor at the University of Ottawa. 

Patients who had inpatient sleep studies may have been chosen because they had multiple health conditions, so these findings will need to be further verified in prospective studies.