Association of Social Deprivation with Wait Time and Referral Attrition in Obstructive Sleep Apnea
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Key Points
Question
Among adults referred for specialist obstructive sleep apnea care, is area-level social deprivation associated with referral attrition or wait times for care?
Findings
In this retrospective cross-sectional study of 3111 patients, higher situational vulnerability was associated with lower odds of receiving a scheduled appointment, whereas higher ethnocultural composition was associated with higher odds. After an appointment was scheduled, social deprivation was not associated with wait time, cancellations, or no-shows.
Meaning
Social inequities in specialist OSA care appear to occur before patients reach the clinic, highlighting completion of referral scheduling pathways as a key intervention to improve equitable access.
Importance
Socially vulnerable patients have a high burden of obstructive sleep apnea, but the stage of the referral pathway at which access barriers arise is uncertain.
Objective
To determine whether area-level social deprivation was associated with appointment scheduling, wait time, cancellations, or no-shows among adults referred for specialist obstructive sleep apnea care.
Design
This was a cross-sectional study evaluating patients referred from December 1, 2016 through November 30, 2019. Data were analyzed from January 30, 2026 to May 16, 2026.
Setting
Foothills Medical Centre Sleep Centre in Calgary, Canada.
Participants
Adults referred to a tertiary academic sleep centre in Calgary, Alberta, Canada. Eligible patients had valid provincial health insurance and either a scheduled clinic appointment or home sleep apnea test data available.
Exposures
Quintiles of the four Canadian Index of Multiple Deprivation domains: residential instability, economic dependency, ethnocultural composition, and situational vulnerability.
Main Outcomes and Measures
The primary outcome was receipt of a scheduled specialist appointment. Secondary outcomes were time from referral to the first attended appointment and number of appointment cancellations or no-shows.
Results
Among 3111 patients (mean [SD] age, 53.7 [14.3] years; 40.7% female), 1766 (56.7%) were scheduled and 1647 (52.9%) attended an appointment. Each quintile increase in situational vulnerability was associated with lower odds of scheduling (adjusted odds ratio [95% confidence interval] 0.86 [0.81-0.92]), whereas each quintile increase in ethnocultural composition was associated with higher odds (adjusted odds ratio [95% confidence interval] 1.32 [1.22-1.43]). Residential instability and economic dependency were not associated with scheduling. No deprivation domain was associated with time to the first attended appointment, cancellations, or no-shows.
Conclusions and Relevance
In this cohort, area-level deprivation was associated with whether patients were scheduled for an appointment but not with wait time or missed visits after scheduling. These findings suggest that equity interventions should focus on completion of referral and scheduling processes.
