Access Barriers, CPAP Reluctance Drive Interest in Home-Based Sleep Apnea Solution

Three persistent barriers are preventing patients with obstructive sleep apnea (OSA) from receiving timely diagnosis and treatment, and the consequences extend well beyond disrupted sleep, according to experts interviewed by The American Journal of Managed Care^®.

Kate Willis, vice president of government and provider strategy at Daybreak, identified referral requirements, lengthy wait times, and limited treatment options as the primary obstacles to care. Patients in rural or remote areas often lack geographic access to sleep labs, she noted, whereas those who do pursue testing face waits of 3 to 6 months, a time during which underlying mental health conditions, including depression, continue to progress.

"The mental health is still progressing and deteriorating, so you've got that lag in wait time," Willis said.

Perhaps equally significant is patient resistance to the dominant treatment option. Many patients avoid testing altogether because they anticipate being prescribed continuous positive airway pressure (CPAP) therapy, a prospect that deters enough patients that some say they would rather remain undiagnosed.

"I've heard a lot of patients say, ‘I'd rather kind of not know,’" Willis explained. "‘I don't want to get tested because I know that ultimately what I'm going to end up with is CPAP.’"

Martin Hopp, MD, PhD, an otolaryngologist and sleep specialist at Cedars-Sinai Medical Center and medical director of Daybreak, emphasized that diagnostic delays compound the problem. Patients rarely arrive at a physician's office and leave with a diagnosis in a single visit; they must navigate multiple referrals before any treatment can begin.

Daybreak's model aims to short-circuit that process. The platform uses a noninvasive, at-home oximetry device worn on the finger for 2 nights; results are reviewed by a physician, and a dentist then assesses the patient for a custom oral appliance. Willis reported that more than 90% of Daybreak patients use their device daily, compared with fewer than 50% for CPAP.

"You can go ahead and get some treatment very effectively with this system," Hopp said, adding that the platform was developed specifically in response to the recognized problem of access and diagnostic delay.