Objectives: Obstructive Sleep Apnea (OSA) remains substantially underdiagnosed in the United States
despite advances in home-based diagnostic technologies. As of 2020, an estimated 5.9 million adults had
been diagnosed with OSA, while 23.5 million remained undiagnosed (Conte et al., 2020). This scoping
review synthesizes recent U.S.-based evidence from the era of expanded home sleep apnea testing
(HSAT) to identify factors contributing to persistent underdiagnosis and to highlight gaps not addressed
in prior reviews.
Methods: A scoping literature search was conducted using PubMed, Embase, and the Cochrane Library to identify studies examining contributors to OSA underdiagnosis. Search terms included obstructive sleep apnea, OSA, underdiagnosis, polysomnography, home sleep apnea testing, socioeconomic factors, and population at risk. Eligible studies were peer-reviewed English-language articles published in the United States between 2015 and 2025 involving adults ≥18 years. Investigators independently screened titles, abstracts, and full texts following PRISMA guidelines. Themes were derived through iterative consensus review of included studies. Study quality was not formally assessed, consistent with scoping review methodology. Of 213 articles identified, seven met final inclusion criteria, representing a key limitation of the evidence base.
Results: Five themes associated with undiagnosed OSA emerged: inadequate screening in high-risk medical populations (n = 6), presence of comorbid conditions (n = 4), limitations or improper use of diagnostic devices including HSAT (n = 3), restricted access to testing and patient reluctance (n = 2), and insufficient physician training in OSA identification (n = 1). Notably, few studies evaluated interventions targeting provider education or implementation of diagnostic tools in high-risk groups.
Conclusions:Persistent OSA underdiagnosis reflects systemic and clinical barriers that remain despite broader HSAT availability. This review highlights the need for targeted interventions addressing provider training, device implementation, and screening integration in high-risk populations. Further research should evaluate strategies to improve diagnostic uptake and clarify how timely OSA treatment affects outcomes in vulnerable groups.
Methods: A scoping literature search was conducted using PubMed, Embase, and the Cochrane Library to identify studies examining contributors to OSA underdiagnosis. Search terms included obstructive sleep apnea, OSA, underdiagnosis, polysomnography, home sleep apnea testing, socioeconomic factors, and population at risk. Eligible studies were peer-reviewed English-language articles published in the United States between 2015 and 2025 involving adults ≥18 years. Investigators independently screened titles, abstracts, and full texts following PRISMA guidelines. Themes were derived through iterative consensus review of included studies. Study quality was not formally assessed, consistent with scoping review methodology. Of 213 articles identified, seven met final inclusion criteria, representing a key limitation of the evidence base.
Results: Five themes associated with undiagnosed OSA emerged: inadequate screening in high-risk medical populations (n = 6), presence of comorbid conditions (n = 4), limitations or improper use of diagnostic devices including HSAT (n = 3), restricted access to testing and patient reluctance (n = 2), and insufficient physician training in OSA identification (n = 1). Notably, few studies evaluated interventions targeting provider education or implementation of diagnostic tools in high-risk groups.
Conclusions:Persistent OSA underdiagnosis reflects systemic and clinical barriers that remain despite broader HSAT availability. This review highlights the need for targeted interventions addressing provider training, device implementation, and screening integration in high-risk populations. Further research should evaluate strategies to improve diagnostic uptake and clarify how timely OSA treatment affects outcomes in vulnerable groups.