0436 Obstructive Sleep Apnea (OSA) Patient Journey: Retrospective Analysis of Real-world Data

Abstract Introduction OSA affects about 30% of US adults and up to 90% remain undiagnosed and untreated. This study aimed to characterize the OSA patient journey by identifying the most common OSA care pathways in the U.S. We also sought to compare time from diagnosis to treatment initiation between groups. Methods Data was extracted from a national administrative claims database (01/01/2016–02/28/2020). Inclusion criteria included age ≥18 years and 12 months continuous enrollment before/after the first OSA diagnosis (index date). OSA was defined as ICD-10 diagnosis preceded by HSAT, in-lab PSG, and/or split-night PSG within the prior 12 months. Exclusion criteria included prior OSA diagnosis/treatment or central sleep apnea. Patient pathway, demographics (at time of OSA diagnosis), timeframes, and comorbidities were assessed. Associations between sex, region, payer, and median patient journey times were investigated using generalized linear models adjusted for baseline characteristics. Results A total of 86,827 OSA patients (45.1% female; median age, 50±11.8) were identified, of which 60.8% initiated PAP therapy, 1.5% received an oral appliance, and 37.6% initiated neither treatment within the year following diagnosis. For patients initiating PAP, the most common care pathways identified for patients, and their median time to treatment initiation were HSAT-only (23.4%, 35 days), PSG+titration (22.9%, 58 days), split-night titration (16.8%, 28 days), PSG-only (11.2%, 37 days), HSAT+HSAT (6.9%, 37 days), titration+titration (3.9%, 31 days) and HSAT+titration (3.5%, 75 days). Relative to patients in PSG-only, individuals in HSAT-only were more likely to initiate PAP (56.1% versus 33.6% initiation). Longer timeframes from sleep test to PAP initiation were observed for patients with commercial insurance versus Supplemental Medicare (OR: 95% CI, 1.10: 1.07–1.14) and females (1.05: 1.04–1.06). There were significant differences in patient timeframes according to region (p< 0.00001). Notable patterns of differences in journey time and PAP initiation were observed based on patient Metropolitan Statistical Area (MSA) diversity and MSA median household income levels, when combined. Conclusion This is the first national analysis to characterize common OSA treatment pathways. Time to treatment initiation varied widely between OSA care pathways. Patient sex, region, payer, and household income were associated with time to treatment initiation. Support (if any) Primasun