0662 A Direct Referral Pathway to Improve Post-Stroke Evaluation of Obstructive Sleep Apnea

Abstract Introduction Stroke is a leading cause of death and disability, affecting nearly 800,000 individuals annually in the US. Obstructive sleep apnea (OSA) is a prevalent comorbidity among stroke survivors, contributing to worse cognitive and functional outcomes. Despite its importance, OSA is underdiagnosed and undertreated after stroke. Most patients rely on traditional outpatient referrals from stroke neurologists or primary care physicians to sleep specialists, a pathway that often results in significant delay. This study evaluates the feasibility and early outcomes of an alternative direct referral pathway to expedite OSA assessment and management after stroke. Methods We implemented a direct referral (DR) pathway allowing stroke neurologists at Thomas Jefferson University Hospital to order sleep studies directly for outpatient stroke/TIA patients at risk for OSA, while the traditional referral (TR) pathway to sleep specialists remained available. Demographic and clinical data were collected for patients referred through either pathway between 12/1/2023 and 11/30/2025. Primary outcomes included initial patient retention, time to study completion, study completion rate, and OSA severity. Between-group differences were analyzed using Student’s t-tests and chi-square tests. Results A total of 180 patients were included (TR: 88; DR: 92). Groups were similar in age (65.1 ± 11.3 vs 66.2 ± 8.8, p= 0.48), sex (48% vs 53% female, p=0.46), race/ethnicity (White 51% vs 59%, p=0.39), BMI (31.8 ± 7.2 vs 31.4 ± 6.0, p=0.69), and mean AHI/REI (18.5 ± 13.9 vs 22.5 ± 20.1, p= 0.33). The DR pathway improved initial patient retention (62% vs. 32%, p= 0.00005) and reduced time to study completion (5 ± 4 weeks vs. 13 ± 8 weeks, p= 0.0003). Study type differed (TR: 61% HSAT, 32% PSG, 7% deferred; DR: 89% HSAT, 11% PSG, p =0.0006). Sleep study completion rates were higher in the TR group (85% vs. 62%, p =0.03). Conclusion The DR pathway for post-stroke OSA evaluation is feasible and substantially improves initial patient retention while markedly reducing time to study completion. It is associated with greater reliance on HSAT and lower study completion rates. Future studies should identify barriers to study completion and assess downstream outcomes in patients referred through the DR pathway. Support (if any)