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Home Sleep Testing and the Sleep Access Gap in America
By Dr. Chelsie Rohrscheib, Wesper
A national look at who is getting tested for sleep apnea at home, and who is still being missed.
Key findings
- In small towns (2,000 to 10,000 residents) with significant healthcare shortages, home sleep testing rates were 66% higher than in similar towns with good access: 7.83 vs. 4.71 tests per 10,000 residents.¹
- In shortage areas, testing rates rose from 1.12 per 10,000 residents within 7 miles of a sleep lab to 2.18 per 10,000 beyond 35 miles.¹
- Residents of the most underserved ZIP codes lived a median 28.8 miles from the nearest in-lab sleep testing provider, compared with 4.7 miles in areas with no shortage designation.¹
- Communities with all three federal shortage designations still tested about 11% less than well-served areas.¹
Why access to sleep testing is uneven
An estimated 83.7 million U.S. adults have obstructive sleep apnea (OSA), and about 80% of them have not been diagnosed.² In-lab polysomnography (PSG) remains an important part of sleep care, and it depends on a sleep center, trained technologists and an overnight stay. Those resources are concentrated in cities and suburbs.
About 92 million people live in areas the federal government designates as primary care Health Professional Shortage Areas (HPSAs).³ For many of them, a sleep study can mean a long drive, time off work, arranging care for family, or a long wait for an appointment.
Home sleep apnea testing (HSAT) lets patients test in their own beds. We wanted to know whether it is reaching the communities that need it most.
What we looked at
We analyzed 57,034 Wesper Lab home sleep test orders from 9,099 ZIP codes in all 50 states, placed between January 2025 and April 2026.¹ Wesper Lab is an FDA-cleared Type III home sleep test.
Each patient ZIP code was matched against federal HPSA designations for primary care, dental care and mental health, and grouped by how many shortage designations it had:
- Good access: no designations
- Moderate shortage: one designation
- Significant shortage: two designations
- Severe shortage: all three designations
Testing rates were adjusted for population using U.S. Census estimates and reported as patients tested per 10,000 residents. We also compared ZIP codes by population size and by distance to the nearest Medicare-enrolled PSG provider, using the 2024 CMS Medicare Physician and Other Practitioners data.⁴
Small towns with healthcare shortages tested more
The clearest pattern showed up in small towns of 2,000 to 10,000 people. Where those towns had significant healthcare shortages, the testing rate was 7.83 per 10,000 residents, compared with 4.71 in similar towns with good access. That is about 66% higher.¹
In larger metro ZIP codes, testing rates were similar across access levels. In cities, home testing may mostly be a matter of convenience. In underserved small towns, it may be the most practical way many patients can get tested at all.
Distance to the nearest sleep lab
Residents of severe-shortage ZIP codes lived a median 28.8 miles from the nearest PSG provider, compared with 4.7 miles for residents of areas with no shortage designation. More than a quarter of severe-shortage ZIP codes (27.9%) were more than an estimated 60-minute drive from a sleep lab, compared with 1.8% of non-shortage ZIP codes.¹
Home testing rose with distance. In shortage areas, the rate nearly doubled from 1.12 per 10,000 residents within 7 miles of a lab to 2.18 per 10,000 beyond 35 miles.¹
The most underserved communities are still behind
ZIP codes with all three shortage designations tested about 11% less than well-served areas. These communities are home to about 1.9 million Americans.¹
Being able to ship a test to someone’s home is only one part of access. People in these areas may also have fewer clinicians who can order a sleep test, less reliable transportation or internet, and less contact with the healthcare system overall.
How patients in shortage areas were referred
Pulmonology and hospital-based referrals had the highest share of patients from shortage areas, which suggests regional medical centers and rural hospital systems are doing a lot of the work of bringing sleep testing to these communities.¹
Telehealth referrals had a lower share of shortage-area patients than we expected. Broadband and technology access may still limit telehealth in parts of rural America. Primary care referrals had the lowest share, which may reflect how often primary care shortages and sleep care shortages overlap.¹
What this means for clinics and health systems
For clinics serving rural or underserved patients, a few practical points come out of this data:
- Hospital and pulmonology teams are already the main referral path for many shortage-area patients, so making home testing easy to order from those teams can reach more of them.
- Distance matters. Patients who live far from a sleep center may be more likely to complete a test that ships to their home.
- The hardest-to-reach communities may also need outreach, help with referrals and support at each step.
Limitations
This was an observational analysis, so it shows associations and cannot prove that shortages caused higher or lower testing. HPSA designations and distance to Medicare-enrolled PSG providers do not capture everything about local access, such as appointment wait times, insurance rules or specialist availability. Testing rates reflect Wesper Lab orders only and do not measure how much sleep apnea goes undiagnosed in each community.
Frequently asked questions
Does home sleep testing help people in rural areas get tested?
In this analysis, small towns with significant healthcare shortages had 66% higher home sleep testing rates than similar towns with good access, and testing rose as distance from a sleep lab increased.
How far do people in underserved areas live from a sleep lab?
Residents of the most underserved ZIP codes lived a median 28.8 miles from the nearest in-lab sleep testing provider, compared with 4.7 miles in areas with no shortage designation. About 28% of those ZIP codes were more than an hour’s drive away.
What is a Health Professional Shortage Area?
A Health Professional Shortage Area (HPSA) is a region the Health Resources and Services Administration designates as having too few primary care, dental or mental health providers for its population. About 92 million people live in primary care HPSAs.
Are the most underserved communities getting tested?
Less than others. ZIP codes with shortage designations in all three categories tested about 11% less than well-served areas, even though they face the biggest barriers to in-lab testing.
Which referral sources reach the most shortage-area patients?
Pulmonology and hospital-based referrals had the highest share of patients from shortage areas. Telehealth and primary care referrals had lower shares.
What’s next
If your clinic or health system serves rural or underserved patients and wants to make sleep testing easier to reach, see how Wesper works, learn about our hospital programs, or book a demo.
Sources
- Rohrscheib C. Home Sleep Testing and the Sleep Access Gap in America. Wesper analysis of 57,034 Wesper Lab HSAT orders, January 2025 to April 2026. Data on file.
- Sönmez I, Vo Dupuy A, Yu KS, Cronin J, Yee J, Azarbarzin A. Unmasking obstructive sleep apnea: Estimated prevalence and impact in the United States. Respiratory Medicine. 2025. sciencedirect.com
- Health Resources and Services Administration, Bureau of Health Workforce. Primary Care Health Professional Shortage Areas, as of December 31, 2025. Via KFF State Health Facts. kff.org
- Centers for Medicare & Medicaid Services. Medicare Physician & Other Practitioners Public Use File, CY 2024. data.cms.gov