As the hospitalist workforce grows, sleep medicine experts suggest that hospitals and their patients could benefit from having sleep medicine hospitalists available, too.

Doing so will make it so “Healthcare providers can mitigate the adverse effects of OSA (obstructive sleep apnea) on patient recovery and long-term health outcomes,” the authors of a 2024 exploration of the sleep medicine hospitalist wrote for Current Pulmonology Reports.

One of the report’s coauthors Kori Ascher, DO, described herself as enthusiastic about what she calls the “profound benefit” of sleep medicine hospitalists as a specialized inpatient service.

“I think everyone realizes the benefits,” said Ascher, an assistant professor in the Division of Pulmonary, Critical Care, and Sleep Medicine at the University of Miami, Miami. “It’s operationally, how can it be executed?”

Benefits of Sleep Experts

Why now, one might ask. Research suggests that nearly 84 million adults in the US are living with obstructive sleep apnea, the most common form of sleep-disordered breathing and a serious condition associated with adverse health outcomes, such as cardiovascular disease (CVD), cognitive impairment, as well as an increased risk for early mortality.

But the prevalence doesn’t guarantee that patients will be monitored for sleep apnea while hospitalized. Currently, sleep apnea is underrecognized in hospitalized patients, according to Karin Johnson, MD, professor of neurology at the UMass Chan School of Medicine - Baystate in Springfield,Massachusetts.

“There’s still a lot of room for improvement,” she said.

If the electronic health record (EHR) isn’t specifically configured to proactively ask patients about existing sleep disorders and their treatment, that information might not make it into their record, Ascher said. In fact, she recently submitted a request to her organization’s information technology department, asking if continuous positive airway pressure use and settings could be incorporated into a patient’s home medications list on the EHR.

“If it’s not part of what you do or the systems that are built into the electronic health record, it’s easy to sort of miss,” Johnson said.

Ascher even encourages patients with existing sleep disorders to advocate for themselves as much as possible. Ascher recommends that they always tell the surgeon and anesthesiologist about their sleep disorder and treatment prior to undergoing any procedures and to always bring along their own device because it’s already preset for their specific needs.

However, inpatient sleep programs could potentially fill gaps. As a 2024 review of research in Current Sleep Medicine Reports noted, “Recently, inpatient sleep medicine programs have emerged as a promising avenue for improving diagnosis, patient safety, and potentially reducing readmissions.” 

Hospitals that proactively incorporate early screening for OSA may realize fewer complications, fewer readmissions, and greater savings down the road.

Recently released clinical guidelines from the American Academy of Sleep Medicine even suggest in-hospital screening for hospitalized patients who are at risk for OSA, as well as a sleep consultation for sleep medicine consultation as part of an evaluation and management pathway for hospitalized patients at an increased for or with an established diagnosis of OSA.

The Biggest Challenges

It may be time for sleep medicine hospitalists, but proponents acknowledge that challenges exist.

“The main issue is going to be the limited availability of sleep-trained physicians,” said Luu Van Pham, MD, a physician specializing in pulmonology, critical care, and sleep medicine and an assistant professor of medicine with Johns Hopkins Medicine in Baltimore. “Just having a person dedicated and being available regularly on an inpatient service is going to be challenging.”

The field is growing, with 102 certified sleep medicine programs across the US offering sleep medicine fellowship opportunities for the 2025-2026 academic year, up from just 84 in 2020, according to the American Academy of Sleep Medicine.

The authors of the 2024 Current Pulmonology Reports study also noted that technology could be a potential barrier.

“Polysomnography, the gold standard diagnostic tool for OSA, is often impractical in hospital settings due to its technical complexity and the requirements for specialized equipment,” they wrote. “This limitation necessitates exploration of alternative diagnostic modalities such as portable sleep monitors and simplified tools, although their accuracy and applicability within hospital environments requires further validation.” 

They added that specialized sleep medicine hospitalists are crucial to provide their expertise and “adeptly navigate these diagnostic complexities, ensuring timely assessments and initiating appropriate therapeutical interventions to optimize patient care and outcomes.”

Another challenge: reimbursement.

“Reimbursement for sleep medicine in the hospital is virtually nonexistent,” Johnson said.

Insurance plans typically do not cover sleep testing in the hospital. “So getting a test that could qualify a patient for treatment while hospitalized is going to be challenging,” Pham said.

“Until payment starts changing, it’s also somewhat of a disincentive for hospitals to invest in a sleep medicine hospitalist,” Johnson said. “It would great if payment models could help support it.”

Future Research

Eventually, sleep medicine hospitalists may become the norm.

Ascher said the existing evidence in support of sleep medicine hospitalists and inpatient sleep medicine is compelling, but more research, including randomized controlled clinical trials, could certainly help provide additional support.

The authors of the Current Sleep Medicine Reports review suggested that future research focus on several aspects, including the direct effects of in-patient sleep medicine programs on the prognosis of patients with CVD and the effects of sleep monitoring for sleep-disordered breathing in the ICU.

For now, hospitals that are working with limited resources may have to focus on what they can do. For example, they could focus on patients with sleep disorders who are at higher risk for adverse outcomes, said Pham. “Sleep disorders are so common that you just don’t have the resources to address sleep problems in everyone,” he added.

If hospitals do not have a full-time sleep medicine physician available in-house, they could also consider other models to provide the necessary care to hospitalized patients, Johnson said.

For example, hospital leaders could consider employing nurse practitioners who are sleep medicine specialists, or they could consult with a sleep medicine physician in the community who could provide telemedicine visits to hospitalized patients.

And that follow-up is crucial, experts say. Johnson noted that studies at her institution have shown a decrease in readmissions among patients with conditions such as chronic obstructive pulmonary disease and heart failure who underwent sleep studies while hospitalized and received treatment and used it appropriately. “Just doing a sleep study is not good enough,” she said. “You need the sleep care coordination pathways set up.”

“You can’t just throw a respiratory device at a patient and hope that things go well,” Pham said. “There have got to be multiple touchpoints and comprehensive support programs to perhaps monitor those patients and check on the patients to make sure they are being treated and make adjustments to the treatment.”