Distance to specialist medical care and diagnosis of obstructive sleep apnea in rural Saskatchewan

Abstract

Background: Obstructive sleep apnea (OSA) is the most common sleep-disordered breathing condition. Rural populations in Canada may be particularly at risk due to high reported levels of obesity, physical inactivity and other related risk factors. Patients with OSA symptoms are often not diagnosed clinically, which is a concern given the health and safety risks associated with unmanaged OSA. The availability of fewer practicing medical specialists combined with longer travel distances to access healthcare services results in barriers to diagnosis and treatment in rural communities.

Objectives: This study aimed to (1) determine whether the proportion of adults reporting OSA symptoms and no sleep apnea diagnosis in rural populations varied by travel distance to specialist medical care; and (2) assess whether any distance-related patterns were attributable to differences in the frequency of sleep apnea diagnosis among adults who may require sleep specialist care.

Methods: We used a cross-sectional epidemiologic study design, with longitudinal confirmation of key findings. Our study base included adults who completed a 2010 baseline questionnaire for the Saskatchewan Rural Health Study; the follow-up phase of the study began in 2014 and ended in 2015. 6525 adults from 3731 households made up our sample. Statistical analyses used log-binomial regression.

Results: Rural adults who reported the largest travel distances (≥ 250 km) to specialist medical care were 1.17 (95% CI: 1.07, 1.29) times more likely to report OSA symptoms and no sleep apnea diagnosis compared to those who reported the smallest (< 100 km) distances. However, the proportion of sleep apnea diagnoses was low and unaffected by reported travel distance among adults who may require sleep specialist care.

Conclusions: In rural Saskatchewan, there was a greater OSA burden among adults reporting the largest travel distances to access specialist medical care, which suggests decreased use of healthcare services in remote populations. However, among adults who may require sleep specialist care, the proportion of sleep apnea diagnoses was low and unaffected by reported travel distance. Other healthcare access barriers may be contributing to the low sleep apnea diagnostic rate and should be evaluated in future research.