The Journal of Clinical Sleep Medicine recently published an expert commentary by Jefferson pulmonologist Sunil Sharma, MD, on hospital sleep medicine programs. Although sleep medicine has traditionally been an outpatient specialty, Dr. Sharma urges sleep specialists to recognize the positive impact that hospital-based sleep programs could have on their patients’ health and well-being.
Because of research connecting sleep disordered breathing with other comorbid disease, an interdisciplinary group of Jefferson leaders asked Dr. Sharma to develop an inpatient sleep service two years ago. The group included Dr. Kane, Interim Chair of Medicine; Dr. Kavuru, Division Director of Pulmonary and Critical Care Medicine; and Dr. Doghramji, Director of the Jefferson Sleep Disorders Center.
The program was developed to screen and treat high risk patients for sleep disordered breathing after they have been admitted to the hospital for other conditions. The team’s goal is to identify any sleep disordered breathing that may be exacerbating other conditions or otherwise affecting the patient’s health.
“We know that sleep disordered breathing has a significant impact on chronic conditions, but the specialty was traditionally absent from the hospital.” said Dr. Sharma. “Research indicates that if we treat sleep disordered breathing, patients’ other chronic conditions such as congestive heart failure can improve and they are less likely to be re-admitted to the hospital.”
The program, one of the first in the region, identifies patients who are at the highest risk for sleep disordered breathing. Patients admitted for heart failure and patients admitted with an elevated body-mass index are screened by a respiratory therapist for sleep disordered breathing using a validated questionnaire. These results are then integrated into a management protocol developed by the pulmonary sleep medicine team. Since the program began, thousands of patients have been screened.
“Our respiratory therapy team really took ownership of the logistics for this program; working with information technology to review daily admissions reports, screening all of the patients, and communicating those results with the entire healthcare team,” said Chip Malloy, Administrator of Pulmonary Services. “Their efforts ensure the program runs smoothly and our patients get the best possible care.”
The highly novel and innovative hospital sleep program is a collaboration between the Division of Pulmonary and Critical Care Medicine, Jefferson Heart Institute, Jefferson Sleep Disorders Center, Respiratory Therapy and Otolaryngology.
“Dr. Sharma, in his editorial, has beautifully articulated the multidisciplinary approach that is needed to take care of the complex disease entity that is heart failure. The triggers for heart failure can be multifactorial. Screening for sleep disordered breathing is vital and can have a profound and pronounced effect on the disease process, ” said Paul J. Mather, M.D., Lubert Family Professor of Cardiology. “Treating the whole patient is necessary and an intrinsic part of the Jefferson mission in order to prevent the otherwise inexorable progression of this disease and improve the patient’s quality of life.”