Implementation of a digital obstructive sleep apnoea pathway in a tertiary respiratory service: a prospective service evaluation

Background: Obstructive sleep apnoea (OSA) is highly prevalent, affecting a substantial proportion of the adult population, but remains frequently underdiagnosed. Traditional face-to-face assessment pathways are slow and resource-intensive, contributing to long waits for diagnosis and treatment. Digitally supported models that combine home testing with virtual review offer a potential solution, yet real-world implementation data from tertiary respiratory services remain limited. Methods: This prospective observational service evaluation examined a digital OSA pathway in a tertiary respiratory service at St. James's Hospital, Dublin, Ireland. During a 17-month period, adults newly referred for suspected OSA were enrolled in the digital pathway, with the option to opt out in favour of a traditional face-to-face clinic review.Enrolled patients completed app-based questionnaires, underwent WatchPAT home sleep testing, and received virtual sleep physician review via a digital platform. Primary outcomes were pathway activity and completion, diagnostic yield, referral-to-review interval, and 6-month continuous positive airway pressure (CPAP) adherence; secondary outcomes included CPAP referral rates and patient satisfaction, and comparison with a retrospective face-to-face clinic cohort. Results: = .13). Overall, 76% of 53 respondents reported satisfaction with the digital pathway. Conclusions: A digitally integrated OSA pathway combining app-based assessment, home WatchPAT testing and virtual review was feasible to implement in a tertiary respiratory service, with high diagnostic yield and acceptable CPAP adherence in a selected cohort. These findings support further evaluation of digitally enabled OSA pathways as a potential model to expand access and reduce reliance on repeated in-person visits, including rigorous assessment of long-term outcomes, cost-effectiveness, and whether all patient groups benefit equally.