Preendoscopic management recommendations include the use of a transfusion threshold of 8 g/dL hemoglobin for most patients and a higher (but unspecified) threshold for patients with cardiovascular disease.

Endoscopic management recommendations include endoscopy within 24 hours of presentation for patients with acute GIB (endoscopy and endoscopic therapy should not be delayed for patients receiving anticoagulation therapy).

Patients with low-risk stigmata (clean-based ulcer) can be fed within 24 hours and discharged with a once-daily proton-pump inhibitor (PPI). Those with high-risk stigmata (active bleeding, visible vessel) should remain hospitalized and treated with a high-dose PPI intravenously for 72 hours (i.e., loading dose followed by continuous infusion). High-risk patients should then be treated with an oral PPI, twice daily, for 14 days before changing to once-daily dosing.

Secondary prophylaxis with PPIs is recommended for all patients with a history of bleeding ulcers who require continued nonsteroidal anti-inflammatory therapy (switching to cyclooxygenase-2 inhibitors should be considered), dual antiplatelet therapy (DAPT), or anticoagulation.

An editorialist notes that some questions of importance to hospitalists, such as the optimal resuscitation strategy for upper GIB patients and the optimal PPI regimen before endoscopy, remain unanswered.

Loud, bothersome snoring; apnea; and oxygen desaturation during sleep are sometimes observed in hospitalized patients. These findings should prompt consideration of OSA.

Several randomized trials have demonstrated that home sleep apnea testing (HSAT), followed by the initiation of treatment in the home, leads to outcomes similar to those of sleep laboratory testing for patients with uncomplicated OSA. HSAT measures several respiratory variables (e.g., oximetry, airflow, chest movement), but does not include electroencephalography. This technology has allowed some patients to be diagnosed and treated by their primary care providers without the need for a formal laboratory sleep study.

Untreated OSA in the perioperative setting is associated with higher rates of cardiopulmonary complications and intensive care unit transfers.

In patients with both OSA and hypertension, continuous positive airway presser (or mandibular advancement devices) can lead to reduced blood pressure, and these reductions are especially great in patients with treatment-refractory hypertension.

内镜检查前的管理建议包括对大多数患者使用8 g / dL血红蛋白的输血阈值，对患有心血管疾病的患者使用更高的阈值（但未指定）。

内镜管理建议包括对急性GIB患者在出诊后24小时内进行内窥镜检查（对于接受抗凝治疗的患者，不应延迟内窥镜检查和内窥镜治疗）。

具有低风险污名（清洁型溃疡）的患者可以在24小时内进食，并每天使用一次质子泵抑制剂（PPI）出院。那些具有高风险污名（活动性出血，可见血管）的患者应继续住院，并通过大剂量PPI静脉治疗72小时（即加药剂量，然后持续输注）。高危患者应改为口服PPI，每天两次，持续14天，然后再改为每天一次。

对于所有有持续性非甾体抗炎治疗（应考虑改用环氧合酶2抑制剂），双重抗血小板治疗（DAPT）或抗凝治疗的出血性溃疡病史的患者，建议进行PPI二级预防。

一位社论专家指出，对住院医生来说一些重要的问题，例如针对上腹部GIB患者的最佳复苏策略和内窥镜检查之前的最佳PPI方案仍未得到解答。

大声打both 呼吸暂停 住院患者有时会观察到睡眠中的氧饱和度降低和氧饱和度下降。这些发现应促使考虑OSA。

几项随机试验表明，家庭睡眠呼吸暂停试验（HSAT），然后在家庭中开始治疗，其结果与无并发症OSA患者的睡眠实验室检查结果相似。HSAT测量几个呼吸变量（例如，血氧饱和度，气流，胸部运动），但不包括脑电图。这项技术使一些患者可以由其初级保健提供者进行诊断和治疗，而无需进行正式的实验室睡眠研究。

围手术期未经治疗的OSA与更高的心肺并发症发生率和重症监护病房转移有关。

在患有OSA和高血压的患者中，持续的气道正压通气（或下颌前移装置）可导致血压降低，而这些降低在难治性高血压患者中尤为明显。