# Improving Access to Sleep Apnea Care: A Pragmatic Study of New Consultation Models

> **NIH VA I01** · VETERANS AFFAIRS MED CTR SAN FRANCISCO · 2020 · —

## Abstract

Project Background: Obstructive sleep apnea (OSA) is one of the most common sleep disorders
among U.S. military Veterans. Unfortunately, most VA sleep programs have not been able to keep
up with Veterans’ ever-increasing demand for OSA assessment and treatment.
Project Objectives: The objective of this proposal is to compare a health care delivery model, Direct Referral
for Apnea Monitoring (DREAM), with initial in-person (IP) encounters for Veterans at risk for OSA. The central
hypothesis of the proposed research is that the DREAM clinical pathway can improve Veterans’ access to
sleep services by reducing wait times for home sleep apnea testing (HSAT) and OSA treatment while
maintaining prognostic accuracy that is comparable to IP assessments. We will test our central hypothesis and
accomplish the objective of this proposal by pursuing the following specific aims:
Aim 1. Compare the time from referral to sleep testing and treatment of OSA in Veterans in the DREAM vs. the
traditional clinical pathway, which includes an initial encounter with a care provider.
Aim 2. Compare positive airway pressure (PAP) adherence and patient-reported clinical outcomes in Veterans
with and without an initial sleep provider encounter.
Aim 3. Determine the negative predictive value of home sleep apnea testing
Significance of the Proposed Research and Relevance to Veterans’ Health: OSA is associated with
increased risk for hypertension, stroke, cardiovascular disease, diabetes mellitus, and premature
death. Improving Veterans’ access to OSA assessment and treatment will improve the quality of
their sleep and the quality of their lives.
HSR&D Priority Areas: 1) Improving Veterans’ healthcare access via telehealth implementation; 2) Testing
new models of care to improve access, cost, and/or outcomes; 3) Design and testing of implementation
strategies to improve uptake of effective practices and quality of care.
Innovation: This approach is innovative because, (a) the use of the DREAM clinical model in lieu of initial IP
consultation for OSA evaluations is novel; (b) using electronic medical record data to triage Veterans directly to
sleep studies is a new application of this technology.
Project Methods: This study is a pragmatic, prospective, observational study that compares a health care
delivery model (DREAM) which is based on data stored in patients’ electronic medical records (EMRs), with
initial in-person (IP) clinic encounters for Veterans at risk for obstructive sleep apnea (OSA). Patients referred
to the participating sleep medicine clinics for OSA will undergo HSAT as appropriate, with subsequent in-lab
sleep testing if the home study is negative. Patient-reported outcomes will be measured at baseline and 3-
months. Adherence with treatment and utilization data will be collected at 3-months.
Expected Results: Compared to the initial IP pathway, DREAM will result in significantly shorter wait times for
Veterans to receive assessment and treatment for OSA. Also...

## Key facts

- **NIH application ID:** 9836752
- **Project number:** 1I01HX002198-01A2
- **Recipient organization:** VETERANS AFFAIRS MED CTR SAN FRANCISCO
- **Principal Investigator:** Eilis A. Boudreau
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2020-08-01 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9836752

## Citation

> US National Institutes of Health, RePORTER application 9836752, Improving Access to Sleep Apnea Care: A Pragmatic Study of New Consultation Models (1I01HX002198-01A2). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9836752. Licensed CC0.

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