Abstract Introduction Obstructive sleep apnea (OSA) results in repetitive collapse of the upper airway during sleep, leading to arousals and intermittent hypoxia. Despite its high prevalence and associated cardiovascular and neurocognitive risks, most cases remain undiagnosed and untreated. Variations in healthcare providers and OSA presentation are challenges in OSA diagnosis. To address this gap and identify opportunities for improvement, we examined data characterizing the patient journey in real-world clinical practice. Methods Data were analyzed from the Adelphi Real World OSA Disease Specific Programme™, a cross-sectional survey of physicians and patients in the United States from April–November 2025. Physicians completed chart reviews, capturing demographic, diagnostic, and clinical outcomes, for up to ten consecutively seen adult patients diagnosed with OSA and not enrolled in OSA trials. Results Overall, 142 physicians (36% primary care physicians PCPs, 31% sleep specialists, 21% pulmonologists, 12% neurologists) reported data for 1,096 patients. Mean (standard deviation) patient age was 53.4 (13.7) years and 66.0% were male. Median IQR time from first reported symptom to diagnosis was 6.9 2.6–19.7 months. At diagnosis, median IQR apnea-hypopnea index (AHI) was 24.0 15.0–36.0 events/hour and most common symptoms were fatigue (55.8%), daytime sleepiness (54.3%) and loud snoring (52.7%); 17.2% did not report any of these classical symptoms. A quarter of patients delayed seeking care for OSA (49.9% didn’t delay, 24.9% don’t know), often due to patient lacking awareness of OSA (53.3%) or denial (40.6%), non-specific signs/symptoms (26.1%), and/or embarrassment (18.8%). Additionally, delays of ≥1-month from first physician visit to diagnoses were reported for 50.8% of patients, commonly due to long sleep-specialist referral times (33.6%) and non-specific signs/symptoms (26.8%). Sleep specialists diagnosed 39.2% of cases; most diagnoses were made by other clinicians, often PCPs (22.0%), pulmonologists (21.5%), neurologists (9.9%). Conclusion Diagnostic delays are common among patients with OSA, often due to limited patient awareness, non-specific symptoms, patient embarrassment, and limited access to sleep specialists. Raising public awareness to improve recognition and reduce stigma, expanding training of non-sleep specialists to support management, and streamlining sleep specialist services to prioritize and increase capacity, may help enable earlier diagnosis and improved outcomes for patients with OSA. Support (if any) Analysis supported by Apnimed, Inc.
Schmickl et al. (2026) studied this question.