Abstract Introduction Obstructive sleep apnea (OSA) is highly prevalent in idiopathic normal-pressure hydrocephalus (iNPH), with studies reporting rates as high as 90%. Similar concerns exist for idiopathic intracranial hypertension (IIH). OSA may worsen headache burden, gait instability, and cognitive dysfunction in these patients. This quality improvement initiative evaluates the referral pathway from USF Neurosurgery to the USF Sleep Disorders Center to identify barriers to timely OSA diagnosis and management. Methods A baseline retrospective review was performed on 13 adults with hydrocephalus or IIH referred for outpatient sleep evaluation between 2024–2025. Eleven referrals were placed during outpatient neurosurgery visits, one during inpatient admission, and one by a non-neurosurgical service. The latter was excluded from neurosurgery-specific timing metrics but included in overall outcomes. Measures included Sleep Medicine consultation, completion of polysomnography/home sleep apnea testing (PSG/HSAT), OSA diagnosis, and PAP initiation. Time intervals were summarized using medians and interquartile ranges (IQR). Results Among 11 patients with outpatient referral timing data, referrals were typically placed at point of care (median 0 days; IQR 0–0; range 0–36). Sleep Medicine consultation was completed in 11/13 patients, with a median delay of 108.5 days (IQR 58–139; range 26–433), representing the primary bottleneck. Diagnostic testing was completed in 7/13 patients, with a median time of 130 days from referral to PSG/HSAT (IQR 100.5–150.5; range 46–209). Among 6/13 patients who completed both consultation and testing, the median time from consultation to PSG/HSAT was 21.5 days (IQR 20–27; range 19–63), indicating shorter delays once evaluated. OSA was diagnosed in 3/7 patients (43%), and 2/3 (67%) of those diagnosed initiated PAP therapy. Delays between Sleep Medicine referral and consultation was the largest contributor to pathway attrition. Conclusion Despite referrals occurring at the time of neurosurgical assessment, prolonged delays before Sleep Medicine evaluation limited timely OSA diagnosis. Planned interventions include a structured decision-support screening and referral algorithm and centralized tracking through Somnoware to improve workflow reliability and accelerate time-to-diagnosis. Continued data collection and evaluation of pathway performance will be conducted as interventions are implemented. Support (if any)
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