E. Lee Murray, MD
CHAPTER CONTENTS
OVERVIEW
Sleep disorders are rarely a reason for hospital admission, but they may become an issue during hospitalization for other reasons. Also, many hospitals routinely screen patients for risk of sleep apnea, especially if anesthesia is contemplated. These disorders are detailed below but are briefly described as follows:
•Obstructive sleep apnea (OSA): Episodes of apnea while sleeping resulting in frequent arousals. Predisposes to respiratory difficulty in the hospital and after discharge.
•Narcolepsy: Excessive daytime sleepiness typically with episodes of weakness or paralysis (cataplexy) which can be mistaken for seizure or stroke.
•Periodic limb movement disorder: Repetitive movements during sleep which cause arousals. Can be mistaken for seizure or myoclonus.
•Insomnia and Sleep Deprivation: Almost universal among hospital patients, predisposes to confusion and possibly hospital psychosis.
OBSTRUCTIVE SLEEP APNEA
Obstructive sleep apnea (OSA) is a common and often undiagnosed disorder. It is most common in middle age, in males, and in patients with elevated BMI. OSA increases the risk of respiratory compromise with sedation and anesthesia.
PRESENTATION is with episodes of apnea while sleeping. Patients often have prominent snoring, frequent arousals during sleep, and excessive daytime sleepiness (EDS). OSA can exacerbate headaches, hypertension, and promote cognitive difficulty.
DIAGNOSIS is considered when a patient has a history of snoring, has elevated BMI, and, in the hospital setting, is being evaluated for a condition with OSA implications such as preoperative evaluation or hypertension. Polysomnography (PSG) is indicated but is seldom performed on acute hospitalization.
Screening for OSA in the hospital setting is usually by a simple evaluation described by the acronym STOP-BANG. If more than two questions in either group are positive, then the risk is substantially increased. If more than two questions are positive in both groups, then the risk of mild sleep apnea is at least 90% and moderate or worse is at least 80%.
