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20 percent of moderate-to-severe cases are formally diagnosed. In practical terms, four out of five people live without a diagnosis,” the Professor points out.
She frames the issue as structural rather than behavioral.“ When a condition is this common yet so rarely identified, the problem is not individual awareness but a structural failure in our diagnostic pathways,” she adds.
In clinical settings, suspicion often sticks to a narrow set of symptoms.“ A key driver of underdiagnosis is the continued reliance on a narrow clinical archetype. Sleep apnea has historically been associated with loud snoring, witnessed breathing pauses, and excessive daytime sleepiness in middle-aged men,” the Professor notes. She contrasts that with what clinicians see every day.“ In practice, symptoms are often subtler and less specific, like persistent fatigue, unrefreshing sleep, headaches, mood changes, or trouble concentrating,” the Professor explains.
She describes how these complaints get redirected.“ Providers often attribute them to stress, aging, mental health, or lifestyle factors in busy primary care settings,” she observes.
The effects of the mismatch vary across patient groups.“ Women and younger patients feel the disconnect more acutely, though they’ re not the only ones affected,” the Professor points out.
She explains how symptom profiles differ.“ Women with sleep apnea are less likely to report classic symptoms like loud snoring, and more likely to present with insomnia, anxiety, depression, or daytime fatigue without obvious sleepiness,” she says.
She highlights how younger adults interpret symptoms.“ Younger adults might notice trouble focusing or lower performance at work, but don’ t always realize they could have a sleep disorder,” the Professor adds. She connects these patterns to delayed testing.“ In both groups, clinicians have a higher threshold for suspicion, and referrals for testing often come late or not at all,” she observes.
Who gets missed
Pediatric care introduces another layer of complexity.“ Children represent a particularly serious and under-recognized dimension of this problem,” the Professor notes. She points out that children’ s symptoms often look different from what adults expect.“ In pediatric populations, sleep-disordered breathing shows up not as sleepiness, but as hyperactivity, impulsivity, irritability, emotional ups and downs, or learning difficulties,” she explains.
She highlights how this creates diagnostic confusion.“ These symptoms closely overlap with behavioral and neurodevelopmental
Structural issues reinforce blind spots. Diagnostic pathways stay centralized, specialist-driven, and tied to legacy reimbursement
diagnoses, especially ADHD, which increases the risk of missing an underlying sleep disorder during critical periods of development,” the Professor adds.
She cites system design as a contributing factor.“ Structural issues reinforce these blind spots. Diagnostic pathways stay centralized, specialist-driven, and tied to legacy reimbursement rules that require referrals to sleep specialists or accredited labs,” the Professor explains.
She notes how incentives affect behavior in primary care.“ General practitioners face both administrative and financial disincentives to start testing, while dentists- despite their ability to spot sleep-disordered breathing- are often left out of the diagnostic process,” she observes. Barriers to access compound the problem.“ Long waits for specialists,
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