Implementation of a WatchPAT‐Based Diagnostic Pathway for Obstructive Sleep Apnea in a Tertiary Hypertension Center: A Feasibility Study

Background Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed in hypertension, affecting 30% to 83% of patients. Limited polysomnography access delays diagnosis. We evaluated the feasibility, diagnostic yield, and downstream management decisions of an integrated diagnostic pathway using WatchPAT 300, a peripheral arterial tonometry‐based home sleep apnea test, in a tertiary hypertension unit. Methods In this single‐center, prospective, observational study, 200 patients underwent ambulatory OSA assessment from May 2023 through August 2025. We recorded clinical variables, peripheral arterial tonometry data, and management decisions. A subgroup underwent confirmatory in‐laboratory polysomnography. Patients were classified as none‐to‐mild OSA (peripheral apneahypopnea index <15/h) and moderate‐to‐severe OSA (≥15/h). Results The pathway achieved 97.5% (95% CI, 94%–99%) technical success and reduced the mean time‐to‐diagnosis to 3.5±4.5 days, versus 154 days for in‐laboratory polysomnography. Over half of the cohort was triaged: ∼30% met treatment criteria directly, and 22% were ruled out. Among patients completing confirmatory polysomnography, 83% (95% CI, 61%–94%) initially classified as none‐to‐mild were reclassified as moderate‐to‐severe OSA, and 77% required treatment. Furthermore, symptoms were dissociated from severity, and Snoring‐Tired‐Observed‐Pressure‐BMI‐Age‐Gender (STOP‐Bag) association with severity did not remain significant after multiplicity correction. Conclusions A peripheral arterial tonometry‐based home sleep apnea test‐first model is feasible and efficient, eliminating diagnostic delays. Although effective for triaging clear‐cut cases, the high reclassification rate underscores the almost mandatory role of confirmatory polysomnography for milder or equivocal results, suspected comorbid sleep disorders, or high STOP‐Bag score. These data argue against symptoms‐based screening alone to screen populations with hypertension.