Patients with suspected obstructive sleep apnoea (OSA) are waiting months for diagnosis and treatment at a major Sydney health service, with new data revealing delays that exceed national guidelines and impose significant out-of-pocket costs.
A 12-month audit conducted at the Nepean Blue Mountains Local Health District found the median wait time for diagnostic polysomnography was 64 days, while patients referred for titration studies waited a median 57 days. Even high-priority cases – defined as meeting severe OSA criteria – faced a median wait of 50 days, despite national recommendations stipulating treatment should begin within 28 days.
“Our patients faced significant wait times for in-lab studies,” report respiratory physician Dr Hamza Azam and colleagues from the Department of Respiratory Medicine, Nepean Hospital in a letter to the Internal Medicine Journal, [link here] noting the region lacked a publicly funded sleep laboratory.
The retrospective audit, conducted in 2022, included 32 patients who completed polysomnography referrals from 44 clinics. Of these, 15 underwent both diagnostic and titration studies, while 13 others were excluded as they did not complete testing. The cohort had a median age of 65.5 years and a high burden of chronic disease, with a median body mass index of 41.9 and common comorbidities including diabetes, hypertension, coronary artery disease and COPD.
Researchers also found it took patients a median 183 days from clinic referral to submission of an application for a government-funded positive airway pressure (PAP) device through EnableNSW. During this time, patients were expected to rent a device to demonstrate compliance, a prerequisite for funding.
But the cost of that rental period was substantial – averaging $1,650 for eligible patients – and often equivalent to purchasing a PAP machine outright, the authors said.
“Median cost to patients to rent PAP devices in the EnableNSW group is equivalent to an outright purchase of automatic PAP devices ranging between $1200 and $2790 recommended retail price,” they noted.
The audit adds to long-standing concerns among sleep physicians about access to diagnostic and therapeutic services for sleep apnoea, particularly in regional and outer metropolitan areas. In response to growing demand, clinicians at the service have begun shifting toward ambulatory studies and auto-titrating devices to reduce the burden on sleep laboratories.
“As most [patients] only required CPAP, we now utilise ambulatory studies,” the authors wrote. “Auto-adjusting PAP devices offer an accurate alternative to in-lab titration, reducing laboratory workload.”
The team also highlighted the value of telehealth and unattended sleep studies in accelerating diagnosis and follow-up.
“Telehealth and unattended ambulatory polysomnography are reliable, avoid delays and expedite follow-up results,” the authors said, citing recent evidence to support the model.
Despite growing recognition of the impact of untreated OSA on quality of life and health outcomes, the authors noted that further research was needed to clarify whether early intervention directly translated to improved long-term clinical results.
Nevertheless, they argued the findings should push development of streamlined pathways to diagnosis and treatment – both to ease the burden on patients and to reduce the long-term costs of untreated sleep-disordered breathing to the health system.