Sleep Apnea & the ICU Patient

• Fragmented ICU sleep worsens delirium and slows weaning; OSA patients desaturate post-op and with opioids.
• Keep home CPAP/BiPAP going in the ICU and screen heart failure patients for central sleep apnea.
• A non-pharmacologic bundle works best: cut noise and light, cluster care, and give day-night cues.
• If a sleep aid is needed, melatonin or ramelteon is preferred — benzodiazepines worsen delirium.

Suggested Workup and Treatment Pathway for ICU Patients With Suspected Severe Obstructive Sleep Apnea–Hypopnea Syndrome (OSAHS)

• Patient with signs/symptoms of severe OSAHS, CSA, or OHS
• Sleep study available as inpatient?
• Bedside sleep study documenting sleep-disordered breathing and titrating CPAP or BiPAP
• Patient has hypercapnia
• Comorbid conditions raising concern for CSA/OHS?
• Overnight oximetry + telemetry + AM ABG, or empiric BiPAP with close monitoring (add backup rate when CSA is a concern)
• BiPAP intolerance → tracheotomy ± nocturnal ventilation
• Empiric CPAP with close overnight oximetry and telemetry monitoring
• CPAP intolerance → tracheotomy