Understanding the Barriers to Care for Individuals Receiving In-Patient Polysomnography: A Retrospective Cohort...

Area of Science:

• Sleep Medicine
• Health Services Research
• Socioeconomic Determinants of Health

Background:

• Fragmented sleep medicine care in Canada disproportionately affects individuals with socioeconomic barriers.
• This fragmentation can result in delayed diagnoses, treatment, and increased healthcare utilization.

Purpose of the Study:

• To investigate if patients receiving polysomnography (PSG) during hospitalization represent a marginalized population.
• To compare the characteristics of patients undergoing inpatient PSG with hospitalized controls and ambulatory clinic controls.

Main Methods:

• Retrospective cohort study of patients undergoing inpatient PSG at a Canadian academic hospital (2019-2021).
• Matched inpatient controls (no PSG) and clinic controls (ambulatory referral) in a 2:1 ratio.
• Comparison of comorbidities, socioeconomic status, rurality, and prior healthcare utilization.

Main Results:

• Inpatient PSG patients exhibited higher comorbidity burden and more specialist visits than both control groups.
• Compared to clinic controls, inpatient PSG patients had greater social disadvantage (marginalization index, social assistance, lower income).
• Inpatient PSG patients experienced higher rates of emergency visits, acute admissions, hospitalization days, and more severe sleep disordered breathing (SDB).

Conclusions:

• Patients evaluated with inpatient PSG demonstrate significant multimorbidity and social disadvantages.
• These findings highlight potential inequities in accessing sleep medicine services.
• Further research is needed to assess the impact of inpatient PSG on untreated SDB complications.