0955 Polysomnographic Outcomes from a Direct to Sleep Lab Referral Program

Abstract Introduction Excessive wait times limit the diagnosis and treatment of obstructive sleep apnea (OSA) in pediatrics worldwide due to limited access to sleep medicine providers, in-lab polysomnography, and surgical treatment for OSA. Further, pediatric patients with public insurance experience higher wait times than their private insurance counterparts, exacerbating disparities in health outcomes. To streamline time to diagnosis and treatment, our department implemented a direct to sleep lab referral process for select specialty care and Primary Care Providers (PCPs) who were trained by our department on identification of sleep related breathing disorders (SRBD). This study looks for differences in severity of sleep disordered breathing between different referring providers. Methods In this retrospective chart review, an electronic medical record (EMR) query for patients above 1 year old and under 18 years old who completed a baseline polysomnogram from 1/1/2023 to 10/31/2025 was performed. PSGs completed prior to MSLTs and any post-operative PSGs were excluded from the dataset. The query yielded a convenience sample of 4,014 subjects. AHIs were compared among provider categories. Results Twelve ordering provider categories were identified. Varying PSG completion counts and average AHIs among specialties were seen. Average AHIs ranged from 4.5/hr. to 16.9/hr. in 2023, 2.0/hr. to 27.4/hr. in 2024, and 0.1/hr. to 16.3/hr. in 2025. No statistical significance in average AHI was seen between sleep providers and outside providers for any year apart from the following low-referring outliers: critical care in 2023, neurosurgery in 2024, and urology in 2025. Through the years, PSGs with AHIs 1/hr. were seen less frequently with 46.9% in 2023, 46.8% in 2024, and 38.4% in 2025. Conclusion This study demonstrates that providers outside of sleep medicine can identify patients who need in-lab polysomnography comparably to sleep medicine providers. Through close collaboration and training, PCPs who screen and make direct to sleep lab referrals, thereby reducing wait times without significant differences in severity of sleep disordered breathing. While further study is required to evaluate other elements of care including age at diagnosis and other sleep study parameters, these results suggest training new resources is a viable way to improve sleep health for children. Support (if any) None