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Understanding Inpatient Sleep Studies for Sleep-Disordered Breathing: A Retrospective Population-Based Study of
Tetyana Kendzerska1,2,3,4, Sachin R Pendharkar5,6,7, Robert Talarico2,3
1Faculty of Medicine, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
CHEST Pulmonary
|August 4, 2026
Summary
Inpatient polysomnography (PSG) patients have higher comorbidity and social disadvantage. Delayed PSG may offer an optimal care model, improving follow-up and positive airway pressure device initiation.
Area of Science:
- Sleep Medicine
- Respiratory Medicine
- Health Services Research
Background:
- The comparative utility of inpatient versus outpatient polysomnography (PSG) for diagnosing sleep-disordered breathing remains unclear.
- Understanding differences in patient characteristics and care patterns is crucial for optimizing sleep medicine services.
Purpose of the Study:
- To compare patient characteristics and post-polysomnography (PSG) care patterns between inpatient, delayed, and outpatient PSG groups.
- To identify potential disparities in sleep medicine follow-up and treatment initiation based on PSG setting.
Main Methods:
- A retrospective population-based study using health administrative data from adult Ontarians (2012-2018).
- Comparison of individuals undergoing inpatient PSG, delayed PSG (within one month post-discharge), and outpatient PSG (no hospitalization in the prior year).
- Outcomes assessed included baseline characteristics, sleep clinic follow-up rates, and positive airway pressure (PAP) device claims.
Main Results:
- The inpatient PSG group (n=748) was smaller and characterized by older age, prior sleep assessment, lower income, and higher comorbidity compared to delayed (n=9,310) and outpatient (n=730,967) groups.
- In adjusted analyses, inpatient PSG patients had lower rates of sleep clinic follow-up (HR 0.79) and PAP initiation (21-53% less likely for CPAP/APAP) but higher rates of bilevel PAP initiation (2-10 times more likely) compared to other groups.
- No significant difference in follow-up was observed between delayed and outpatient PSG groups.
Conclusions:
- Inpatient PSG patients represent a distinct subgroup with significant comorbidity and social disadvantage.
- The delayed PSG model shows promise as an optimal care pathway, warranting further investigation in prospective studies.
- Findings highlight potential inequities in sleep disorder diagnosis and treatment based on PSG setting.
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