Table 1.

—Critical Care Considerations in the Patient With Suspected Sleep-Disordered Breathing

Recommendation	Rationale
Consider comorbid OSA, OHS, or the overlap syndrome in patients with ventilatory failure.	Many patients with SDB have not received a diagnosis at the time of acute cardiopulmonary failure.
	Failure to diagnose SDB may lead to increased morbidity or mortality.
Look for and treat OSA in CHF.	NIV may improve left ventricular ejection fraction and outcomes.
Consider OSA in patients who survive cardiac arrest.	Untreated OSA may represent a potentially reversible cause of sudden death.
Consider early empiric NIV for ventilatory failure in appropriate candidates.	SDB is treated directly and complications of endotracheal intubation and sedation are avoided.
Consider extubation to NIV as a liberation strategy when patients require endotracheal intubation.	NIV may reduce postextubation respiratory failure.
	Some obese patients are capable of spontaneous breathing even though they do not meet the traditional success criteria on spontaneous breathing trials.
Consider performing spontaneous breathing trials on higher CPAP or PEEP levels.	Higher levels of end-expiratory pressure may be necessary to offset increased chest wall elastic load even when lung compliance is acceptable.
Use sedation and analgesia judiciously.	Opiates and benzodiazepines promote pharyngeal collapsibility, blunt respiratory drive, and impair the arousal mechanism.
Limit sleep disruption at night.	SDB is worsened by sleep deprivation.
Arrange close follow-up with sleep specialist.	Chronic SDB should be formally diagnosed and treated.

CHF = congestive heart failure; CPAP = continuous positive airway pressure; NIV = noninvasive ventilation; OHS = obesity hypoventilation syndrome; OSA = obstructive sleep apnea; PEEP = positive end-expiratory pressure; SDB = sleep-disordered breathing.