DARIEN, IL – A new study to be presented at the SLEEP 2026 annual meeting found that patients at high risk for obstructive sleep apnea who receive primary care in rural settings are less likely to be referred for sleep apnea evaluation than those in urban areas, even after accounting for individual and neighborhood socioeconomic factors.
Results show that among 25,917 high-risk patients, only 15% of rural patients received a referral for sleep apnea evaluation compared with 20% of urban patients. After adjusting for age, sex, race, body mass index, insurance, state, and Area Deprivation Index, rural patients had 25% lower odds of receiving a sleep apnea referral compared with urban patients. Among those who were referred, rural patients had a higher median BMI and lived in neighborhoods with greater socioeconomic disadvantage compared with referred urban patients.
"These findings highlight that geographic location is an independent factor in whether high-risk patients are referred for obstructive sleep apnea evaluation in primary care," said principal investigator Dr. Joscilin Mathew, sleep medicine fellow at the Cleveland Clinic. "Understanding the barriers specific to rural settings will be important for reducing these disparities."
Obstructive sleep apnea is a common sleep disorder in which the upper airway repeatedly collapses during sleep, causing disruptions in breathing. It is estimated that 54 million adults in the U.S. have sleep apnea , and 24 million adults have moderate to severe obstructive sleep apnea nationwide. Left untreated, sleep apnea is associated with increased risk for high blood pressure, heart disease, stroke, and type 2 diabetes.
The retrospective cohort study used electronic medical records from the Cleveland Clinic Health System in Ohio and Florida to identify adult patients at high risk for sleep apnea who were seen in primary care from 2017 to 2024. High-risk patients were defined by the presence of obesity, relevant cardiovascular or metabolic comorbidities, a BMI greater than 35 kg/m², or a STOP Questionnaire score of 2 or higher. Rural and urban residence was classified using Rural-Urban Community Area codes. The study included 3,874 rural patients and 22,043 urban patients.
The study's authors emphasized that the findings point to a need for targeted strategies to improve access to sleep apnea evaluation in rural primary care.
"Patients in rural areas may face unique structural barriers to accessing sleep medicine care, and primary care-based models for obstructive sleep apnea evaluation may be one avenue for addressing these gaps," said senior author Dr. Cinthya Peña Orbea, assistant professor of medicine at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University.
The research abstract was published recently in an online supplement of the journal Sleep and will be presented June 15 during SLEEP 2026 in Baltimore. SLEEP is the annual meeting of the Associated Professional Sleep Societies, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society during SLEEP 2026 in Baltimore. SLEEP is the annual meeting of the Associated Professional Sleep Societies, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society.
