Implementation of a WatchPAT-Based Diagnostic Pathway for Obstructive Sleep Apnea in a Tertiary Hypertension Center:...

Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed in hypertension, affecting 30% to 83% of patients. Limited polysomnography access delays diagnosis. We evaluated the feasibility, diagnostic yield, and downstream management decisions of an integrated diagnostic pathway using WatchPAT 300, a peripheral arterial tonometry-based home sleep apnea test, in a tertiary hypertension unit.

In this single-center, prospective, observational study, 200 patients underwent ambulatory OSA assessment from May 2023 through August 2025. We recorded clinical variables, peripheral arterial tonometry data, and management decisions. A subgroup underwent confirmatory in-laboratory polysomnography. Patients were classified as none-to-mild OSA (peripheral apneahypopnea index <15/h) and moderate-to-severe OSA (≥15/h).

The pathway achieved 97.5% (95% CI, 94%-99%) technical success and reduced the mean time-to-diagnosis to 3.5±4.5 days, versus 154 days for in-laboratory polysomnography. Over half of the cohort was triaged: ∼30% met treatment criteria directly, and 22% were ruled out. Among patients completing confirmatory polysomnography, 83% (95% CI, 61%-94%) initially classified as none-to-mild were reclassified as moderate-to-severe OSA, and 77% required treatment. Furthermore, symptoms were dissociated from severity, and Snoring-Tired-Observed-Pressure-BMI-Age-Gender (STOP-Bag) association with severity did not remain significant after multiplicity correction.

A peripheral arterial tonometry-based home sleep apnea test-first model is feasible and efficient, eliminating diagnostic delays. Although effective for triaging clear-cut cases, the high reclassification rate underscores the almost mandatory role of confirmatory polysomnography for milder or equivocal results, suspected comorbid sleep disorders, or high STOP-Bag score. These data argue against symptoms-based screening alone to screen populations with hypertension.