Implementation of a digital obstructive sleep apnoea pathway in a tertiary respiratory service: a prospective service evaluation.

Background: Obstructive sleep apnoea (OSA) is highly prevalent, affecting a substantial proportion of the adult population, but remains frequently underdiagnosed. Traditional face-to-face assessment pathways are slow and resource-intensive, contributing to long waits for diagnosis and treatment. Digitally supported models that combine home testing with virtual review offer a potential solution, yet real-world implementation data from tertiary respiratory services remain limited. Methods: This prospective observational service evaluation examined a digital OSA pathway in a tertiary respiratory service at St. James's Hospital, Dublin, Ireland. During a 17-month period, adults newly referred for suspected OSA were enrolled in the digital pathway, with the option to opt out in favour of a traditional face-to-face clinic review.Enrolled patients completed app-based questionnaires, underwent WatchPAT home sleep testing, and received virtual sleep physician review via a digital platform. Primary outcomes were pathway activity and completion, diagnostic yield, referral-to-review interval, and 6-month continuous positive airway pressure (CPAP) adherence; secondary outcomes included CPAP referral rates and patient satisfaction, and comparison with a retrospective face-to-face clinic cohort. Results: Over 17 months, 23 digital clinics delivered 160 appointments to 118 patients, of whom 104 (88.1%) completed WatchPAT testing. Diagnostic yield was high, with 81/104 tests (77.9%) positive and a mean apnoea hypopnea index (AHI) in the severe range. Mean referral-to-review interval was 5.5 months. Of those with a positive test, 52 (64.2%) commenced CPAP, of whom 29 (55.8%) met standard 6-month adherence criteria.By comparison, 69 patients treated via the standard pathway commenced CPAP and 29 (42.0%) were adherent, corresponding to an odds ratio for adherence of 1.74 (95% confidence interval 0.84-3.60; Conclusions: A digitally integrated OSA pathway combining app-based assessment, home WatchPAT testing and virtual review was feasible to implement in a tertiary respiratory service, with high diagnostic yield and acceptable CPAP adherence in a selected cohort. These findings support further evaluation of digitally enabled OSA pathways as a potential model to expand access and reduce reliance on repeated in-person visits, including rigorous assessment of long-term outcomes, cost-effectiveness, and whether all patient groups benefit equally.