1223 Primary Care Versus Sleep Medicine Management of Obstructive Sleep Apnea: A Pathway-Based Analysis of Treatment Adherence and Personalization

Abstract Introduction Obstructive sleep apnea (OSA) is common but often underdiagnosed and undertreated. Expanding the role of primary care providers (PCPs) may improve timely diagnosis and treatment of OSA, but patients report higher positive airway pressure (PAP) therapy adherence when cared for by specialists at centers accredited by the American Academy of Sleep Medicine. At Mayo Clinic, PCPs are now authorized to order home sleep apnea testing (HSAT) and subsequent therapy; HSAT is reviewed and interpreted by Sleep Medicine specialists (SMSs), but patients receive diagnoses and treatment recommendations through their PCP. This retrospective 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 their HSAT was ordered and initially managed by a PCP or SMS. Initial sleep metrics, PAP therapy adherence data, and other management details (treatments offered and key dates in the care pathway) were compared across groups. Results Once HSAT had been ordered, provider type was not associated with meaningful discrepancies in diagnosis and treatment timeliness; PCP-managed patients waited just one additional day after the interpretation of their HSAT to be offered treatment (p=0.025). However, consultation with Sleep Medicine introduced upfront delays caused by limited access to specialty care. The total time in the OSA care pathway, between referral to a SMS or pre-HSAT evaluation to the offering of treatment was 113 days for SMS patients versus 28 days for PCP patients (p< 0.001). Additionally, SMSs identified more co-occurring sleep disorders and discussed a broader range of treatment options with their patients, who demonstrated nightly PAP usage of 1.15 hours longer on average. Conclusion Despite differing modes of patient communication, PCPs offer timely OSA testing and diagnosis, allowing patients to bypass lengthy specialty care wait times. However, future efforts are needed to address variations in the counseling provided, and to ensure that all patients are equipped to succeed with PAP therapy. These findings support primary care pathways for uncomplicated OSA while highlighting the need for enhanced education and support to optimize patient outcomes. Support (if any)