0652 Inpatient Screening & Management of Obstructive Sleep Apnea in Medically Ill Patients: A Systematic Review

Abstract Introduction Obstructive Sleep Apnea (OSA) is prevalent and underdiagnosed in hospitalized adults. Untreated OSA may contribute to complications, including respiratory depression and cardiovascular events. The 2025 AASM guideline issued conditional recommendations for inpatient screening and PAP therapy. This review evaluates the impact of hospital based OSA screening and management on clinical outcomes. Methods We searched major databases published between 2010 and 2025, evaluating inpatient OSA screening and treatment. Inclusions criteria were randomized controlled trials (RCTs), cohort studies, and QI projects reporting outcomes such as mortality, length of stay (LOS), ICU transfers, and readmissions. Eight studies met inclusion criteria which included four QI projects, three retrospective cohorts, and one prospective cohort. Results STOP-Bang screening was feasible and identified high-risk patients (13–30% of admissions). A 5-year QI study (n=254,000) showed mortality reduction from 2.1% to 1.9% (p 0.001) in patients monitored based on STOP-Bang score. However, screening alone did not reduce LOS or readmissions. In a cardiac unit study (n=1,981), STOP-Bang score did not predict readmission or LOS. A large cohort (n=3 million) found lower mortality in known OSA patients (aOR 0.71), but CPAP use during hospitalization was associated with higher mortality (aOR 1.51), likely due to confounding. Conclusion Inpatient OSA screening and monitoring may improve safety, particularly in high risk patients receiving sedatives. However, evidence for acute PAP therapy improving outcomes is limited. Further trials are needed to assess long-term benefits and cost-effectiveness. Support (if any) Lauer A, Smith J, Patel R, et al. Implementation of STOP-Bang–based monitoring for hospitalized patients receiving sedatives: A quality improvement initiative across seven hospitals. BMJ Open Qual. 2024;13(1):e002345. doi:10.1136/bmjoq-2023-002345. Ogbu UC, Brown DL, Patel SR, et al. Association of obstructive sleep apnea and inpatient outcomes in acute cardiovascular admissions: Analysis of 3 million hospitalizations. BMJ Open. 2024;14(2):e067890. doi:10.1136/bmjopen-2023-067890.