Sleep medicine practices in India: Insights from a national survey

Dear Editor, We are writing to present the findings of a sleep survey that we conducted to assess the current landscape of sleep services in India, with a specific focus on obstructive sleep apnoea (OSA). OSA has an estimated population prevalence of 11% across India, but there is limited data exploring sleep services across the country.[1] More broadly, there is considerable disparity between urban and rural health care, and only 37% of the population is covered by health insurance and patients often bear the cost of their healthcare, particularly within sleep medicine.[2,3] The primary objective of our survey was to evaluate the current availability and practice of sleep medicine in India, from the perspective of medical professionals. The secondary objective was to identify significant barriers and challenges within these services. The survey was designed in conjunction with an Indian expert in sleep medicine to ensure the details collected were relevant. Informed consent was obtained by an introductory statement included on the survey. The final survey can be seen in the supplementary material. Convenience sampling was used, with data collected between January and May 2025, and then analysed using IBM SPSS (version 30.0, Armonk, NY, USA). The survey was exempt from Institutional Ethics Committee approval. There were 78 responses available for analysis after removal of erroneous entries. Most respondents were respiratory physicians (+/–) critical care, accounting for 84%, with 59% of respondents working predominantly in the private healthcare sector. The majority (n = 59, 76%) of respondents had received formal training in level 1 PSG, with just over half (n = 40, 51%) were trained in level 3 multi-channel PSG. The number of referrals was estimated by respondents at 253 (±175) patients per year and the most common referral source to sleep services was from patients themselves (83%). A summary of screening practices and study protocols is shown in Table 1.Table 1: Screening practices and study protocols among Indian sleep physiciansRespondents estimated that 56.7% (standard deviation = 18.9) of performed sleep studies yielded a diagnosis of moderate–severe OSA, with continuous positive airway pressure (CPAP) recommended as first-line intervention for 92% of these patients (n = 72). For asymptomatic mild OSA, lifestyle measures were recommended as a first-line treatment option (n = 61, 78%), with 10% advising referral to ENT ± surgery in the first instance. For symptomatic mild OSA, most patients were recommended CPAP as the first-line intervention (n = 49, 63%), followed by lifestyle measures (n = 22, 28%). The patient was responsible for paying for treatment in 92% of cases (n = 72). The estimated cost of different treatment modalities reported by respondents is shown in Figure 1, where 1 INR is equivalent to approximately 0.011 USD.Figure 1: Estimated costs of different treatment options for OSA. OSA = Obstructive sleep apnoeaOnly 49.1% of patients purchased CPAP or a mandibular advancement device as prescribed and patient compliance with purchased treatment averaged 55.7%. Alternative therapies were offered to patients by 43% of respondents (n = 33). These included lifestyle changes (diet modification, alcohol avoidance, weight reduction), oropharyngeal strengthening exercises and adoption of specific sleeping postures. For monitoring patients, telemedicine was utilised by only 20% of respondents. Where further information was given, four respondents documented that their application of telemedicine was in the form of a telephone or video call to the patient. This is the first survey to explore the current state of Indian sleep services, from the perspective of the medical professionals working within the speciality. Overall, the survey results highlight significant variability in institutional sleep practices, including methods of screening referrals and the approach to patients with mild OSA. There is more consistency across services regarding the first-line management of moderate–severe OSA. Despite the high yield of patient’s being diagnosed with moderate–severe OSA, the uptake of prescribed CPAP is low and overall compliance is poor. There is limited uptake of telemedicine in sleep services across the country, which could represent an untapped opportunity within sleep services to improve access across the country. Overall, these data highlight the urgent need for subsided treatment access and structured referral pathways. Further work should focus on evaluating the role of telemedicine to improve coverage across the country. Financial support and sponsorship Nil. Conflict of interest Nil.