The study was based on the theory of the Model of Pathways to Treatment. The application of the Model of Pathways to Treatment in the study made up for the lack of theoretical support in previous studies on the delay in medical treatment of patients with OSA. According to the theory, the patient’s delay was divided into appraisal interval, help-seeking interval, diagnostic interval. And most importantly, we were able to clearly understand the most obvious part of the patient’s delay, which was the appraisal interval. After that, we have analyzed the factors that affected the delays in seeking medical attention from the perspectives of the individual, the disease, and the health service system. So, the results provided a powerful intervention direction for future research and the public health administration. However, one thing to be clear was that the self-reported intervals in the interviews were estimated by the events of special significance in their lives, which was impossible to pinpoint the exact date.

It can be seen that the delay rate for patients with OSA in seeking health care is relatively high. The interviews show that the shortest delay interval for patients with OSA to seek health care behavior is 0.5 years, all of which are more than 3 months, with a delay rate of 100% and the longest time being 50 years. As far as the respondents were concerned, they often didn’t aware the fact that they were snoring during the sleep, the leading cause of delayed medical treatment. They didn’t realize it until they were told by their spouse or roommate. Furthermore, traditional wisdom holds that snoring is a sign of good health and happiness, or the snoring is a blessing in Chinese culture. In the situation, they don’t know what OSA is and how harmful it is to the target organ. They assumed that snoring was not a big deal even though they already knew that they were snoring in the sleep, which was most obvious in the 13 patients with a family history of snoring. It’s not surprising that the subjects with the false perception had a long delay in seeking medical advice. What’s more, the subjects with lower social support, were more likely to delay in seeking medical treatment than those with higher social support mainly from their spouses [5, 9,10,11]. Besides, the subjects often use busyness as an excuse to delay seeking medical attention [12]. However, this phenomenon is more evident in the middle-aged and elderly than in the young and middle-aged. Patients in the young and middle-aged, the life stage of “having both parents and young children to support and take care of”, may pay more attention to the health because a strong sense of responsibility forces them to keep healthy, which promotes them to seek medical treatment as soon as possible [13]. Factors related to the disease itself are as follows: firstly, our results showed that atypical or vague symptoms of OSA led to longer pre-diagnostic intervals, except for those typical symptoms, such as frequent suffocation in the sleep or falling asleep while waiting for a traffic light. The symptoms are usually little by little aggravated, not as urgent as a heart attack or a brain hemorrhage, which are usually life-threatening. The respondents reported that their symptoms were daytime sleepiness but far from affecting their daily lives [14]. None of the respondents had ever been to the emergency room for their symptoms. Furthermore, it’s well known that OSA and obesity are mutually causal. Most of the obese patients thought their symptoms would ease after losing weight. The health system’s organization mainly affect the delay in diagnostic interval and pre-treatment interval of patients with OSA. The study indicated that health resources were unequal: some patients complained that local hospitals had a lower medical level and were far away from superior hospitals, for that reason, there were few integrated prevention and control networks of hospitals at all levels. Some factors resulting in patients not receiving timely diagnosis and treatment have been shown, such as imperfect sleep monitoring equipment, a lack of multidisciplinary sleep diagnosis centers, fewer sleep monitoring beds per capita, and complex medical procedures in hospitals with inconvenient emergency room green paths, a longer waiting time for examination, and insufficient understanding of the OSA for some medical staff [15,16,17,18]. The medical treatment behavior of OSA patients would have been affected by country medical insurance policies, reimbursement modes and proportions of provinces and cities, and coverage of private medical insurance [18,19,20,21,22,23]. For example, the government fully bears the treatment cost of OSA in France, while it only partially reimburses the surgical treatment cost of OSA in China. Its first-line treatment, CPAP, is still self-funded in China. Now, Polysomnographic monitoring is not included in routine hospital physical examinations or in special populations, for example, drivers and obese people. Thus, it is recommended that PSG should been included in routine physical examination for patients with obesity or other special conditions, even if they have no symptoms.

National health authorities should make corresponding publicity for patients, so that the general public gradually understand the OSA and its harm, and the corresponding treatment. Medical-seeking behavior is primarily the result of personal knowledge, attitude/belief and practice [24, 25]. Compared with chronic diseases such as hypertension and diabetes, OSA has a lower awareness rate [26]. The results indicated that eight participants (respondents 3, 6, 9, 10, 11, 12, 13, 15) were unaware of OSA, six participants (respondents 4, 7, 8, 1, 2, 14) had heard of OSA as a disorder but did not take it seriously, and only one participant (respondents 5) had known about it. One in 15 participants opted for CPAP within one year, which is far lower than the 50 percent reported [27]. The damages and complications of OSA to target organs cannot be recognized properly and in time [28], and then timely treatment is not possible after diagnosis. Patients may choose treatment only when accompanied by severe symptoms, resulting in a lower treatment level. At the same time, the medical staff’s cognition of OSA should also be improved to ensure the alertness of OSA [29, 30]. Our analysis indicated that it is possible to prompt early medical treatment and standardize treatment management for patients with OSA, provided that awareness of OSA is increased.

Diseases have their own natural evolutionary progression, which no intervention can change. In this case, we can’t change the path of it, but can only detect it early. Currently, Polysomnography is not included in routine medical examinations in China. Thus, we recommend that different strategies are needed for the different types of people in routine medical check-ups. For special high-risk occupational groups, like a driver, OSA screening for every commercial driver is advocated, given under-resources medical system. In addition, Polysomnography test should be prescribed by clinicians in routine medical check-ups for those special populations who have a short neck with small jaws, rhinitis, excess fat with a neck circumference of more than 40 cm [31].

In addition, the state and the government should vigorously adjust medical resources and strengthen the attention to primary hospitals by improving the relevant diagnostic equipment to improve the situation. It is necessary to establish a diagnosis and treatment system suitable for grassroots work and train medical teams that can stick to working at the grassroots level for a long time and are familiar with the diagnosis and treatment technology of OSA. It is more important to establish a comprehensive prevention and control network based on grassroots medical institutions and coordinated by hospitals at all levels. And further national health authorities need to increase the reimbursement rate for the treatment of OSA, both surgical and CPAP for further improving situation of OSA patients’ medical treatment. Let it be sooner rather than later.