New research shows geographic location is an independent factor in whether high-risk patients receive evaluations for obstructive sleep apnea in primary care settings.
RT’s Three Key Takeaways:
- Geographic Referral Disparity: Rural patients at high risk for obstructive sleep apnea have 25% lower odds of receiving a referral for evaluation compared to their urban counterparts.
- Socioeconomic and Clinical Factors: Referred rural patients often live in neighborhoods with greater socioeconomic disadvantage and present with a higher median body mass index than urban patients.
- Need for Targeted Strategies: Researchers emphasize that primary care-based models may help address structural barriers to sleep medicine care in rural healthcare settings.
Patients at high risk for obstructive sleep apnea (OSA) who receive primary care in rural settings are significantly less likely to be referred for evaluation than those in urban areas, according to a study presented at Sleep 2026.
The retrospective cohort study analyzed electronic medical records from the Cleveland Clinic Health System in Ohio and Florida, identifying 25,917 high-risk adult patients seen in primary care between 2017 and 2024. Results indicated that only 15% of rural patients received a referral for evaluation compared with 20% of urban patients.
After adjusting for age, sex, race, body mass index (BMI), insurance, and the Area Deprivation Index, rural patients had 25% lower odds of receiving a referral. Among those who were referred, rural residents lived in neighborhoods with greater socioeconomic disadvantage and had a higher median BMI than urban patients, according to the study data.
“These findings highlight that geographic location is an independent factor in whether high-risk patients are referred for obstructive sleep apnea evaluation in primary care,” said Joscilin Mathew, sleep medicine fellow at the Cleveland Clinic. “Understanding the barriers specific to rural settings will be important for reducing these disparities.”
OSA is a respiratory disorder characterized by the repeated collapse of the upper airway during sleep, which disrupts breathing. It affects an estimated 54 million adults in the US. If left untreated, the condition is associated with an increased risk for heart disease, stroke, type 2 diabetes, and high blood pressure.
The study authors suggested that primary care-based models could bridge the gap in access. “Patients in rural areas may face unique structural barriers to accessing sleep medicine care, and primary care-based models for obstructive sleep apnea evaluation may be one avenue for addressing these gaps,” said Cinthya Peña Orbea, assistant professor of medicine at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University.
High-risk patients in the study were defined by a BMI greater than 35 kg/m², relevant cardiovascular or metabolic comorbidities, obesity, or a STOP Questionnaire score of 2 or higher. Rural and urban residence was classified using Rural-Urban Community Area codes. The study included 3,874 rural patients and 22,043 urban patients.
