Barriers to Care for Sleep Surgery at a Safety Net Hospital: Qualitative Patient Experiences

Understanding barriers to surgical interventions for obstructive sleep apnea (OSA) is crucial to ensuring equity of access to OSA care. This study aims to understand the experiences of patients at a safety-net hospital in getting treatment for OSA.

We used semi-structured interviews of adult patients with OSA presenting to the Zuckerberg San Francisco General Hospital Otolaryngology -Head and Neck Surgery clinic. Interviews consisted of open-ended questions focusing on barriers to sleep apnea care and surgery. These interviews were recorded and transcribed. Thematic analysis using the Consensual Qualitative Review methodology was performed by two reviewers.

15 adult patients with OSA were interviewed. Subthemes were identified and then grouped into four major barriers to sleep surgery, which included: (1) limited knowledge about treatment options and instructions, (2) healthcare delivery delays, (3) negative perceptions of health care, and (4) financial and logistical limitations. Patients utilized various resources for their health information, including physicians, word of mouth from family or friends, Youtube, television, and Tiktok.

Lack of knowledge of sleep surgical options and referral delays pose major challenges to sleep surgery care in underserved populations. Future interventions should include accessible educational videos or tools to improve health literacy on OSA treatments and multidisciplinary programs across several sleep-related specialties to facilitate timely discussion of CPAP alternatives.

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