0482 Sleep Apnea Diagnosis Disparities from Serious Mental Illness in a Veteran Cohort

Abstract

Introduction Sleep apnea (SA) diagnosis requires multiple steps including an office visit and testing. People with serious mental illness (SMI) may require a longer time from referral to diagnosis and be less likely to complete the full diagnostic pathway because of functional limitations. Methods A retrospective cohort of VA Northeast Ohio Healthcare System Veterans referred for sleep medicine consultation (1/1/2010-12/31/2020). Dates of consultation, sleep clinic visits, and testing was collected in addition to demographics, past medical history, and medications at the time of initial consultation. SMI was defined as a composite of schizophrenia, schizoaffective disorder, and bipolar diagnosed disorder before the initial consultation. The outcome was defined as the time until fulfilling minimal SA diagnostic pathway defined as completing both a sleep clinic appointment and at last one sleep test. Relationships between SMI and pathway completion were tested using survival analyses. Analyses were adjusted for age, sex, race, insurance status, service connection percent, Medicare eligibility, marital status, alcohol use, and drug use to account for other potential sources of health disparities. Sensitivity analyses evaluated differences in time to pathway completion via the Wilcoxon-Mann-Whitney test. Results The cohort (n=11,030) was primarily male (91.1%), with mean age of 55.8 ±14.4 yrs, with mean body mass index of 32.9 ± 6.4 kg/m2, and a mean pathway completion in 71 days, interquartile range (IQR): [33, 135]. Those with SMI had similar pathway completion rates (89.9% in SMI vs. 90.2% without), but a longer time to completion (83 days, IQR = [35.5, 185.5] in SMI vs. 70 days IQR: [32, 132]). Pathway completion time was significantly higher in those with SMI (Wilcoxon rank sum test difference = 9.0 days, 95%CI: [4.0, 14.0]. ]SMI was associated with a lower hazard of time to pathway completion (HR = 0.87, 95% confidence interval (CI): [0.91, 0.94] in unadjusted and HR = 0.87, 95%CI:[0.81, 0.94]. Conclusion Although pathway completion rates were similar, Veterans with SMI were more likely to take longer before pathway completion. Additional investigation of factors that delay pathway completion may offer tailored avenues to improve the time to diagnosis. Support (if any) VA CSR&D IK2CX001882