RT Journal Article
SR Electronic
T1 Impact of Educational Resources for Primary Care OSA Management on Referral Patterns
JF medRxiv
FD Cold Spring Harbor Laboratory Press
SP 2026.01.21.26344482
DO 10.64898/2026.01.21.26344482
A1 Zouboules, Shaelynn
A1 Tsai, Willis H.
A1 David, Oliver
A1 Ip-Buting, Ada
A1 Povitz, Marcus
A1 Gerlitz, Reg
A1 Fabreau, Gabriel E.
A1 Woiceshyn, Jaana
A1 Flemons, W. Ward
A1 Donald, Maoliosa
A1 McBrien, Kerry
A1 Pendharkar, Sachin R.
YR 2026
UL http://medrxiv.org/content/early/2026/01/22/2026.01.21.26344482.abstract
AB Background/Objective Barriers in access to care have prompted development of innovative care delivery models for patients with obstructive sleep apnea (OSA). One such innovation is management of uncomplicated OSA by primary care providers (PCPs), which reserves specialist capacity for more complex patients. We developed a clinical guideline and subsequently, an online clinical pathway to support PCPs in OSA management. We aimed to evaluate the impact of these initiatives on PCP behaviour by assessing changes in the complexity of newly referred patients.Methods We compared data for new OSA referrals to the Foothills Medical Centre Sleep Centre in Calgary, Canada, received during three distinct referral periods: prior to the clinical guideline (November 2016 – March 2017; Period 1), after implementation of the clinical guideline (April 2017 – November 2018; Period 2), and after publication of the online primary care pathway (December 2018 – November 2019; Period 3). The primary outcome was OSA severity as defined by the oxygen desaturation index (ODI) on home sleep apnea testing performed at the time of referral. Secondary outcomes included severity of daytime sleepiness and proportion of patients with severe OSA or severe daytime sleepiness at the time of referral. Multivariable linear and logistic regression models were constructed to quantify the associations between study outcomes and Period after adjustment for baseline covariates.Results Among the 2489 patients with sleep study data available, patients referred in Period 3 had more severe OSA (ODI, mean nocturnal oxygen saturation, proportion with severe OSA) compared to patients referred in earlier Periods. Severity of sleepiness did not increase across Periods. In multivariable analysis adjusting for demographics and comorbidities, ODI was significantly associated with Period (regression coefficient 1.70 (0.39, 3), p = 0.011) but severe OSA was not (odds ratio 1.17 (0.99, 1.39), p = 0.069).Conclusions OSA severity increased following implementation of educational resources to support primary care OSA management. These findings suggest that with appropriate supports, PCPs may be more comfortable managing less severe OSA patients independently and only refer more severe cases for specialist consultation.Competing Interest StatementSachin R. Pendharkar has received honoraria and grant funding from Jazz Pharmaceuticals. Outside of the submitted work, Marcus Povitz has received a fellowship grant from Paladin Labs and contract research from Jazz Pharmaceuticals.Funding StatementThis work was supported by a Canadian Institutes of Health Research (CIHR) Project Grant and a Jazz Pharmaceuticals Sponsorship GrantAuthor DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:The Conjoint Health Research Ethics Board of the University of Calgary gave ethical approval for this work.I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesThe data underlying this study cannot be shared due to research ethics board requirements which protect the confidentiality of the research participants.