Dr. Susheel Patil Leads National Panel Drafting Clinical Practice Guidelines for Sleep Medicine

Innovations in Pulmonology, Critical Care & Sleep Medicine | Fall 2025

Susheel Patil, MD, PhD

The Journal of Clinical Sleep Medicine recently published two sets of standards for the management of inpatient sleep apnea and central sleep apnea, co-authored by Susheel Patil, MD, PhD. Dr. Patil is the System Director of Sleep Medicine at University Hospitals Cleveland Medical Center, serves on the board of directors of the American Academy of Sleep Medicine (AASM) and chairs the organization’s Guideline Advisory Panel (GAP).

With more than 11,000 members worldwide, AASM advances sleep medicine and advocates for both patients and providers. The organization also commissions expert task forces to conduct systematic literature reviews and develop clinical practice guidelines.

“We utilized the GRADE [Grading of Recommendations Assessment, Development and Evaluation] methodology, which allows us to examine the current state of evidence to inform best-practices recommendations,” Dr. Patil says. “The GRADE process allows for making decisions even when the scientific evidence base is less than ideal or randomized trials have not been performed. The process aims to make the decision-making process transparent to users so that they can understand the strength of a recommendation and the certainty of the evidence behind the recommendation.”

Each task force, composed of six to eight experts, seeks input from stakeholders throughout the process and develops a set of PICO questions (patient/population/problem, intervention, comparison and outcome) as part of the methodology. After drafting a guideline, there are periods for scholarly review and public comment before a final version is published. Then, the dissemination process begins. The AASM offers webinars, conference sessions and at-a-glance summaries to communicate the information to clinicians.

“The guidelines represent the standard of care to help inform treatment decisions, but it is important to realize that nothing replaces clinician judgment because each patient’s situation and values are distinct,” Dr. Patil says.

Management of Inpatient Sleep Apnea

The AASM guideline for inpatient sleep apnea (ISA) is the first standard issued by a professional society to address this prevalent condition in the hospital setting. Sleep apnea raises risk in conditions, such as heart failure, stroke or COPD, and may contribute to readmission rates.

“The document is written from the perspective of supporting the clinicians treating these patients,” Dr. Patil says. “We understand that too many patients with sleep apnea are underdiagnosed or undertreated, and the hospital setting may serve as an opportunity to identify patients who are at elevated risk.”

While recognizing the variability of resources available across different health care settings, the guidelines recommend in-hospital screenings or consultations with sleep medicine specialists, respiratory therapists or other allied health professionals. “If we are able to identify these high-risk patients, clinicians can diagnose sleep apnea during inpatient stays or recommend a consultation shortly after discharge,” Dr. Patil says.

For patients already established with sleep apnea therapy, the new guideline recommends continuing their treatment during their hospital stay.

“For the majority of patients, we advise that they bring their sleep apnea devices to the hospital because machine settings and mask interfaces are customized to their specific needs,” Dr. Patil says. “Hospitals are places where sleep is disrupted due to medical conditions or the need for around-the-clock care, and we want to optimize sleep as much as possible.”

Management of Central Sleep Apnea

AASM’s central sleep apnea (CSA) guideline updates and revises previously published recommendations. CSA is much less common and often occurs alongside obstructive sleep apnea, which results in a lack of definitive research findings.

“Although the strength of evidence for different CSA treatment varies, our goal in writing this document was to provide clinicians with expert consensus on how to approach these patients,” Dr. Patil says. “The key message is that we should consider the severity of central sleep apnea along with patient-reported outcomes, such as daytime sleepiness, poor sleep quality and poor quality of life, when making treatment decisions.”

One update to the CSA care standards is the recommendation regarding adaptive servo-ventilation (ASV), a form of positive airway pressure therapy that automatically adjusts to a patient's breathing.

“Previously, it was recommended not to use ASV in the heart failure population with reduced ejection fraction [HFrEF], but once the task force looked at the evidence, it was recommended that it may be appropriate to consider the treatment in certain patients with HFrEF,” Dr. Patil says. “However, this care should be limited to centers with sufficient experience and resources.”

Another CSA treatment that received a conditional recommendation is transvenous phrenic nerve stimulation (TPNS), a minimally invasive procedure in which a device is placed under the skin to deliver electrical impulses to the phrenic nerve, stimulating the diaphragm to contract and helping to prevent breathing pauses.

University Hospitals Cleveland Medical Center is one of the few locations in the country offering this relatively new technique. “In partnership with our cardiology colleagues who implant the device, we are considering patients who have difficulty tolerating traditional therapies for TPNS,” Dr. Patil says.

Increasing pPrevalence and Underdiagnosis of Sleep Apnea

It is very common for people to report snoring, poor sleep quality or daytime sleepiness. However, 80 to 90 percent of patients with sleep apnea remain undiagnosed and untreated. Reaching this population requires a multidisciplinary approach.

“The reality is that there are not enough sleep specialists to support every patient with a sleep problem, so sleep apnea often needs to be addressed in primary care settings,” Dr. Patil says. “However, it is important for both patients and providers to recognize that you don't have to go it alone — sleep specialists are here to help, and we are doing our best to provide support and resources to our primary care colleagues.”

For more information, contact Dr. Patil at Susheel.Patil@UHhospitals.org.

Contributing Expert:
Susheel Patil, MD, PhD
System Director, Sleep Medicine
University Hospitals Cleveland Medical Center
Clinical Associate Professor
Case Western Reserve University School of Medicine