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

Fragmented care models for sleep medicine in Canada disadvantage individuals with socioeconomic barriers. This can lead to delays in diagnoses, treatment, and increased health care utilization. BACKGROUND: Fragmented care models for sleep medicine in Canada disadvantages individuals with socioeconomic barriers. This can lead to delays in diagnoses, treatment, and increased health care utilization. This study aimed to explore whether subjects who receive polysomnography (PSG) during hospitalization represent a marginalised population. METHODS: We identified subjects who underwent PSG during hospitalization (inpatient PSG) at an academic hospital in Canada, from January 1, 2019, to December 31, 2021. Time, age- and sex-matched control groups were derived in a 2:1 allocation ratio inclusive of: hospitalized individuals who did not undergo PSG (inpatient control) and individuals referred to an ambulatory sleep medicine clinic (clinic control). Comorbidities, socioeconomic deprivation and marginalization indices, rurality, and health care utilization within the preceding year to enrollment, were compared between groups. RESULTS: We matched 275 inpatient PSG with 550 inpatient control and 550 clinic control subjects. Compared to both control groups, the inpatient PSG group had greater burden of comorbidities and more frequent specialist physician appointments. They had greater marginalization index, social assistance use, and lower income levels compared to clinic control subjects. More frequent emergency department visits, acute care admissions, and days in hospital were observed in the inpatient PSG group compared to clinic control subjects. Inpatient PSG subjects had more severe sleep disordered breathing (SDB) compared to clinic control subjects. CONCLUSIONS: Subjects evaluated with in-patient PSG had a greater multimorbidity, social disadvantages, and health care usage. Future prospective trials are needed to determine whether routine use of in-patient PSGs can reduce complications associated with untreated SDB.