The Patient Journey for OSA
A Review and Discussion of Pain Points / Areas of Disruption
Obstructive sleep apnea (OSA) is an under diagnosed and impactful chronic condition in medicine. While multiple worthwhile treatment options exist, the process of getting from symptom onset to treatment is often frustrating, fragmented, and slow.
In this post, we’ll walk through the typical patient journey—from first experiencing symptoms to navigating testing, diagnosis, and treatment. We’ll also highlight pain points in the system and spotlight opportunities, along with the emerging players/technologies trying to improve the current model.
1. Symptom Onset and Primary Care: The Missed Window
For most patients, the journey begins not with a sleep specialist, but with years of fatigue, snoring, and vague complaints of poor sleep quality. Maybe their partner notices or the patient suffers alone. Daytime sleepiness is often misattributed to aging, parenting, burnout, or depression.
📉 Pain Point:
Providers often don’t screen for OSA unless prompted by specific symptoms like loud snoring or witnessed apneas.
📊 Data:
Studies estimate the average time from symptom onset to diagnosis is 5+ years.
It is frequently stated that 80% of people with OSA remain undiagnosed, according to estimates from the AASM and NIH, however the exact percentage can vary considering the OSA definition and target population.
🛠Disruption Potential:
Public health announcements, consumer awareness campaigns (e.g., Philips, ResMed) and direct-to-consumer outreach encouraging patients to discuss their symptoms with physicians.
Self-screening tools and validated questionnaires (e.g., STOP-Bang via digital apps)
Startups like Lofta and SnoreLab help users self-identify red flags and bypass bypass traditional front door for sleep testing (direct to consumer/virtual visit)
Wearables like the Apple Watch and Samsung are tracking sleep data and beginning to pitch sleep apnea feedback. The field of wearable sleep trackers is quickly approaching clinical utility.
2. Testing Delays and Insurance Barriers
Even when suspicion is raised, getting a test isn’t immediate. The process is usually constrained by ordering/pickup, insurance approvals, and availability of testing equipment.
📉 Pain Point:
Home sleep tests often take 2–6 weeks from ordering to completion; in-lab studies can take several months (in busy practices, this can easily go past 4 months) to schedule.
📊 Data:
Numerous studies have documented significant delays from referral to diagnosis in OSA.
Insurance often requires prior authorization for in-lab studies, especially if the patient doesn’t meet strict criteria.
🛠Disruption Potential:
Lofta, BetterNight, Singular Sleep, and WatchPAT Direct offer direct-to-consumer, home-based testing—sometimes with results and follow-up in less than a week.
Virtual care models (e.g., Sleep Doctor, Primasun, Ognomy) integrate testing, diagnosis, and prescription into a single platform. Essentially bypassing the traditional evaluation model.
3. Result Interpretation and Follow-Up Gaps
Even after testing, many patients report delays in hearing results or understanding their diagnosis. Follow-up appointments with sleep specialists add another layer of waiting.
📉 Pain Point:
Patients may wait weeks or longer to review results, especially if they are funneled back through busy specialists.
📊 Data:
A 2022 patient survey found 1 in 4 OSA patients waited more than a month after testing to start any form of treatment.
Many reported confusion over what the results actually meant or which treatments were available.
🛠Disruption Potential:
Integrated telehealth platforms with asynchronous result reviews quicker
AI-assisted reports to help patients visualize and interpret their AHI and oxygen data
Consumer-facing education tools
4. First-Line Treatment: CPAP... or Bust?
Once diagnosed, most patients are prescribed CPAP—often without a full discussion of alternatives. While CPAP is gold-standard upfront therapy, initial experiences can be uncomfortable or overwhelming without proper support.
📉 Pain Point:
Many patients fail to adapt to CPAP due to mask discomfort, pressure intolerance, or a lack of follow-up coaching. Approximately 50% stop in the first year.
📊 Data:
CPAP non-adherence rates remain high across multiple studies.
Insurers may discontinue payment if adherence metrics aren’t met within 30–90 days.
🛠Disruption Potential:
App-connected CPAPs (e.g., ResMed’s AirSense with MyAir) to enhance monitoring/support
Coaching-based models and direct to consumer marketing to offer remote support
Multiple new treatment options and devices (e.g., eXciteOSA, oral appliances, GLP’s, Apnimed AD-106) are expanding non surgical modalities.
5. Discussion of Surgery
Patients who fail CPAP often give up entirely. Discussions around possible surgical therapies (like UPPP or Inspire) often come late—or not at all.
📉 Pain Point:
Access to surgical treatments is often limited by a lack of knowledge about them, availability of providers, surgical hesitancy, or cost/coverage challenges.
📊 Data:
Surgical OSA rates remain low despite significant market volume
🛠Disruption Potential:
Inspire Medical, Nyxoah, and LivaNova bringing implant-based alternatives to market
Integrated surgical centers focusing on sleep surgery (e.g., ENT-led sleep centers, Inspire centers of excellence)
🚧 Final Thoughts: A System Ripe for Redesign
The current OSA care model is slow, fragmented, and biased toward one-size-fits-all solutions. But the landscape is shifting. Virtual platforms, consumer tech, and new therapies are driving a more patient-centered, data-driven model.
Still, true disruption won’t come from any one device or app—it will come from rethinking the journey itself: connecting symptoms to solutions faster, increasing knowledge for providers (not just sleep surgeons), and making that journey smoother for the millions still undiagnosed.
Thank you for your ongoing support. - Chris and Robson.