On-site AASM-accredited sleep facility status and hospitalization outcomes among adults admitted with acute hypercapnic respiratory failure: a retrospective cohort study

Objectives: Acute hypercapnic respiratory failure (AHRF) is a common cause of hospitalization among adults with chronic respiratory and sleep-related disorders. We evaluated whether admission to hospitals with an on-site American Academy of Sleep Medicine (AASM)-accredited sleep facility was associated with length of stay (LOS) and hospitalization cost among adults admitted with AHRF. Methods: We conducted a retrospective cohort study using the Healthcare Cost and Utilization Project New York State Inpatient Database from 2017 to 2021. Adults admitted to hospitals outside New York City were included because hospital density, referral patterns, and access to specialty services differ from those in New York City. Hospitals were classified by the presence of an on-site AASM-accredited sleep facility, used as a structural proxy for institutional sleep medicine capacity. LOS and hospitalization cost were log10-transformed before analysis. We used bivariate analyses and hierarchical multivariable linear regression models adjusting for demographic, clinical, socioeconomic, and hospital-level covariates. Results: A total of 3,247 adults met inclusion criteria. In unadjusted analyses, admission to hospitals with an on-site AASM-accredited sleep facility was associated with shorter LOS and lower hospitalization cost. After adjustment, sleep facility status was not independently associated with either outcome and did not improve model fit. Greater comorbidity burden was the strongest independent predictor of both longer LOS and higher cost. Housing instability and race categorized as other than White were also associated with higher resource use. Chronic obstructive pulmonary disease was independently associated with shorter LOS and lower cost. Conclusions: Among adults hospitalized with AHRF, LOS and hospitalization cost were more strongly associated with comorbidity burden and socioeconomic disadvantage than with the presence of an on-site AASM-accredited sleep facility. These findings suggest that accreditation status alone may not capture inpatient sleep medicine processes most relevant to acute respiratory care.