1225 Predictors of Post-Discharge Sleep Apnea Care Adherence in Rural Appalachia

Abstract Introduction Under-recognition of sleep apnea in hospitalized patients is well documented and contributes to adverse outcomes, including higher readmissions and mortality. Even when sleep apnea is detected during hospitalization, patients must complete post-discharge diagnostic testing and follow-up to achieve meaningful clinical benefit. In rural Appalachia, follow-up rates have historically been low. This study sought to identify factors associated with poor post-discharge completion of recommended sleep studies and clinic visits in this population. Methods As part of a formal clinical care pathway at a rural tertiary care center, patients admitted to medicine and heart failure services were screened for sleep apnea. Those screening positive received a comprehensive sleep medicine consultation, structured education, and recommendations for a post-discharge split-night polysomnogram and sleep clinic follow-up. Rural–Urban Commuting Area (RUCA) codes were assigned for each patient. Health literacy scores, demographics, and comorbidities were collected. Fisher’s exact test and logistic regression were used to identify factors associated with poor post-discharge adherence. Results A total of 294 consecutive inpatients who screened positive for sleep apnea were followed for at least 90 days. The mean age was 61 years (range 20–86), and mean BMI was 37 kg/m² (range 17–87); 56% were male. Overall, 25% completed the recommended sleep study and 21% attended a sleep clinic visit after discharge. Higher health literacy (OR 3.59) and greater disease severity based on apnea–hypopnea index (AHI) (OR 1.016) were independently associated with higher rates of follow-up. In contrast, RUCA code—reflecting rurality—was not associated with post-discharge compliance. Conclusion In this rural Appalachian cohort, poor health literacy and milder sleep apnea severity were the key factors independently associated with lower post-discharge follow-up for diagnostic testing and clinic care, whereas rurality did not influence adherence. Interventions focused on improving patient education, enhancing health literacy, and prioritizing follow-up among patients with milder disease may help increase post-discharge compliance and optimize downstream outcomes. Support (if any)