Barriers to Care for Obstructive Sleep Apnea: Primary Care Perspectives at a Safety Net Hospital

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Objective: Given the prevalence of obstructive sleep apnea (OSA) and sparsity of sleep medicine specialists, OSA management often depends on primary care providers (PCPs). We investigate PCP experiences managing OSA within a community health network (CHN) serving underserved patients. Methods: Mixed-methods study was performed with surveys and focused interviews. CHN providers in San Francisco were interviewed. Results: Ten providers (7 PCPs and 3 sleep medicine specialists) were interviewed. A group of 29 PCPs that worked for public institutions were surveyed. Identified patient barriers to OSA care included health care navigation difficulties (70%), low health literacy (68%), and housing and income-related PAP use limitations (60%). Provider barriers included resource constraints (90%), provider knowledge about OSA disease and PAP troubleshooting (68%), and insurance coverage for sleep studies/PAP equipment (68%). The main barrier to PAP alternative therapy was PCP unfamiliarity with options (80%). While sleep specialists preferred managing OSA from time of PAP presentation, 36% of PCPs refer only after PAP noncompliance despite 78% feeling uncomfortable with PAP management and 96% with less than 3 h of formal OSA training. Most PCPs are interested in learning about PAP troubleshooting (79%) and PAP alternatives (56%). Conclusion: PCPs report limited comfort in managing OSA, troubleshooting PAP, and assessing for PAP alternatives. Barriers to OSA care include healthcare navigation difficulties, insurance, and resource constraints. Both PCPs and sleep specialists report unfamiliarity with PAP alternatives. Educational materials aimed at OSA management, PAP troubleshooting, and PAP alternatives may improve equitable OSA care delivery. Level of Evidence: 3- Mixed-method study with qualitative and quantitative data.

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