________________________________________________________________________________________________________________________
Sleep seen clearly
Professor Esther Rodriguez Villegas on diagnostic pathways, reimbursement, and home testing in sleep apnea care
In everyday clinical practice, signs usually show up before a diagnosis. One patient comes in with resistant hypertension. Another deals with fatigue that never goes away. A third has trouble focusing on work or school. These cases circulate through primary care, cardiology, endocrinology, psychiatry, and pediatrics all the time. Yet sleep almost never takes center stage in the diagnostic process, even when symptoms suggest it should. It leads to care pathways that treat the effects while the root cause often remains untested.
For health systems, the gap impacts utilization, costs, and outcomes. Patients move through visits, medications, and referrals. Employers notice more injuries and lost productivity. Families experience academic and behavioral challenges. Meanwhile, the diagnostic pathway for sleep apnea still follows an old model built around specialist access, lab capacity, and reimbursement structures that favor
24