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Background Obstructive sleep apnoea (OSA) affects an estimated 5% of UK adults and is increasingly prevalent. The Respiratory ‘ Getting it Right First Time’ report highlights the urgent need for more efficient, innovative models of care in Sleep Medicine to address rising demand with assessment of OSA often representing one third of referrals into Respiratory Medicine. Although mild asymptomatic OSA often requires no intervention, traditional referral pathways typically result in outpatient reviews for all patients. This approach places strain on services, delaying timely access to care for those with greater need and consuming significant NHS resources.Methods We piloted a digital, consultant-led pathway at a large inner-city tertiary hospital for patients with mild OSA who were not excessively symptomatic. Following direct-to-test sleep studies, patients with an AHI of 5–15/hr and Epworth Sleepiness Score ≤16 were assessed for suitability. Those with self-reported English fluency and smartphone proficiency were eligible. In place of a routine appointment, patients received a diagnostic letter with detailed written advice on purchasing a semi-bespoke mandibular advancement device (MAD). SMS follow-up at 8 and 20 weeks offered options to confirm MAD purchase and request an appointment or opt-out. Patients were discharged unless engagement or clinical concern prompted further review.Results Between January 2022 and April 2025, 462 patients were enrolled (baseline characteristics summarised in table 1). Of these, 221 patients (47.8%) demonstrated engagement via text response. 183 (39.6%) patients proceeded to clinic review (164 positive responders and 19 for other reasons) and 278 (60.2%) were discharged without outpatient review, either due to non-engagement (n=221, 47.8%) or opting-out (n=57, 12.3%). Only 11 patients (2.4%) were re-referred, mostly from the non-response group, suggesting a low risk of missed clinically significant disease. Avoiding 278 appointments generated an estimated cost saving of over £50,000 based on standard NHS tariffs, while reducing outpatient burden and freeing clinician time for more complex cases.Abstract P46 Table 1Baseline characteristics of all patients enrolled in the pathway, those who were discharged (non-responders or opt out) and those who proceeded to outpatient review. Note that 1 patient passed awayConclusion This digital pathway safely triaged low-risk mild OSA patients, significantly reducing unnecessary outpatient activity. With high discharge rates, low re-referral and substantial resource savings, it represents a scalable and sustainable model for modern Sleep Medicine services.