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Home sleep apnea testing (HSAT) has largely supplanted diagnostic polysomnography. Primary care (PC) driven HSAT utilization is common especially in rural settings that lack sleep specialist (SS) support. There have been no studies comparing appropriateness of HSAT utilization in veterans managed by SS vs. PC. Methods We use hub and spoke model to manage patients with OSA. SS selects testing for hub and PC utilizes HSAT for spoke patients. Testing is interpreted by SS. Patients referred for HSAT using WatchPAT over 4 months were compared on test failure rate, adherence to AASM guidelines for OSA diagnosis, adherence to HSAT use criteria, and diagnostic success rate (AHI ≥5) in high risk patients (STOPBANG ≥5) without significant comorbidities or HSAT contraindications compared to all comers. Results There were 125 hub and 170 spoke patients included in the analyses. Baseline characteristics were similar between sites (gender, age, BMI, Epworth sleepiness scale, neck size, STOPBANG, pacemaker dependence, and medication use affecting HSAT). Spoke patients had slightly higher prevalence of comorbidities (hypertension, cardiac arrhythmia, heart failure, COPD, stroke, and long acting opioid use). Complete HSAT failure (no data) was 2% and technical failure (monitoring time &amp;lt;4 hours) was 13% at both sites. Unnecessary studies primarily to confirm OSA in those previously diagnosed on therapy seeking to establish care were 3% (hub) and 21% (spoke). HSAT done in patients without significant comorbidities was 77% (hub) and 68% (spoke). Adherence to HSAT use criteria was 74% at both sites. Diagnostic success rate of prespecified and all comers was 65% vs. 60% at hub and 86% vs. 64% at spoke sites. Conclusion Adherence to AASM guidelines and HSAT use criteria was overall fair with low failure rates. Further improving HSAT protocol for SS and PC with the aim to improve diagnostic success rate and minimize unnecessary studies should be pursued. Support  

0605 Comparison of Sleep Specialist vs Primary Care Driven Home Sleep Apnea Testing in Routine Practice