Table 2.

Proposed Criteria for Patients Most Appropriate for Hub vs Spoke-Based Care

Hub Care	Spoke Care
Initial care: •Predominant insomnia symptoms •Active psychiatric disease or cognitive impairment •Patients at high risk for central sleep apnea or hypoventilation syndromes •Low pretest probability of OSA and minimal daytime sleepiness who request testing/treatment	Initial care: •Absence of clinical suspicion of sleep related-hypoventilation and central sleep apnea •High diagnostic likelihood of moderate-to-severe OSA •Absence of comorbid sleep disorders (eg, insomnia, restless leg syndrome, parasomnias)
Follow-up care: •Significant hypoxemia on initial sleep testing •Inability to tolerate initial PAP therapy •Patients interested in non-PAP therapies (mandibular advancement device, sleep surgery)	Follow-up care: •Able to tolerate PAP therapy •Patients who have initiated non-PAP therapies with adequate initial response •Patients with high-risk comorbidities who have completed initial hub-based treatment

See Table 1 legend for expansion of abbreviation.