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Sleep Medicine

(1323) Disparities in the diagnosis and treatment of obstructive sleep apnea: an Epic Cosmos analysis

Saturday, October 17, 2026

Presenting Author(s)

Gillian M. Michaelson, MD

Research Fellow
Department of Otolaryngology – Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Case Western Reserve University School of Medicine
Philadelphia, Pennsylvania, United States

Co-Author(s)

Robert P. Duncheskie

Medical Student
Department of Otolaryngology – Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Case Western Reserve University School of Medicine
Philadelphia, PA, United States

Senior Author(s)

Ahmed M.S Soliman, MD

Professor & Vice Chair
Department of Otolaryngology – Head and Neck Surgery, Lewis Katz School of Medicine at Temple University
Philadelphia, PA, United States

Introduction: Surgical interventions represent an important component of therapy for obstructive sleep apnea (OSA), more so with the increasing recognition of the benefits of hypoglossal nerve stimulation. Barriers and disparities to accessing this care are not fully understood. This study investigates the association between socioeconomic and demographic factors and surgical treatment of OSA.

Methods: A retrospective cohort study was conducted with de-identified data from the Epic Cosmos network. Adults with a new diagnosis of OSA from Jan. 1, 2015-Dec 31, 2025, were divided into a surgical or non-surgical group based on Current Procedural Terminology (CPT) codes for surgical OSA treatment, including relevant codes for surgeries involving bone, soft tissue, and hypoglossal nerve stimulation. Patient characteristics were compared between the two groups.

Results: A total of 7,822,528 patients with a new diagnosis of obstructive sleep apnea were identified. Of these, 65,434 (0.84%) were treated surgically. Most patients with OSA were white (72%), male (57%), English speaking (88%), and lived in a metropolitan area (81%). Patients who underwent surgery for OSA were more likely to be white (74% vs 72%, p< 0.001), younger (48.8 +/- 16.4 vs 57.4 +/- 14.3, p< 0.001), healthier (as measured by Epic’s risk of admission or emergency department visit score calculator, 16.1/100 vs 17.9/100 p< 0.001), and have commercial insurance (84% vs 76%, p< 0.001).

Conclusions: This study highlights significant demographic and socioeconomic disparities in the diagnosis and surgical treatment of obstructive sleep apnea over the past 10 years and supports existing research on this subject. Future studies should focus on identifying drivers of this disparity.