Primary care versus sleep specialist pathways for obstructive sleep apnea with home testing: access, adherence, and treatment personalization.

PURPOSE: Although expanding obstructive sleep apnea (OSA) management capabilities has been a longstanding goal, patients report higher positive airway pressure (PAP) therapy compliance when cared for by specialists at centers accredited by the American Academy of Sleep Medicine (AASM) [1]. At Mayo Clinic, primary care providers (PCPs) are now authorized to order home sleep apnea testing (HSAT) and subsequent therapy, eliminating the need for consultation with Sleep Medicine. This study evaluates whether patients diagnosed with OSA through primary and specialty care pathways experience comparable timeliness of care, counseling about therapeutic options, and PAP adherence.

METHODS

Fifty-five patients were selected from each of two groups, based on whether HSAT was ordered and initially managed by a PCP or sleep medicine specialist (SMS). Initial sleep metrics, PAP adherence, and key management details (treatments offered and care timelines) were compared across groups.

RESULTS

Although provider type was not associated with meaningful discrepancies in diagnosis and treatment timeliness once HSAT was ordered, consultation with a SMS introduced upfront delays caused by limited access to specialty care. SMSs discussed a larger range of treatment options, however, and patients seen by a SMS were more adherent to therapy, using PAP ≥ 4 h for an additional 13% of nights and for 1.15 h longer per night.

CONCLUSION

Despite differing modes of patient communication, PCPs offer timely OSA testing and diagnosis. However, further efforts are needed to address variations in the breadth of counseling provided, and to ensure that all patients are equipped to succeed with PAP therapy.