<p>To assess the frequency of dysphagia diagnosis in patients with OSA, characterize the use of clinical and instrumental swallowing evaluations, and identify gaps in care contributing to the underdiagnosis of unsafe swallowing in this population. Patients with OSA were identified using ICD-10 code G47.33 in the TriNetX Research Network, and those who had not undergone polysomnography were excluded. The prevalence of dysphagia (ICD-10 R13.1) and associated sequelae, including aspiration pneumonia (ICD-10 J69.0), was evaluated. Swallowing assessments were captured using CPT codes for clinical and instrumental evaluations. Of 1,328,355 patients with OSA, 15% had a documented diagnosis of dysphagia. The majority were coded with unspecified dysphagia (85%), followed by oropharyngeal dysphagia (21%). Sequelae of dysphagia, including aspiration pneumonia, malnutrition, and gastrotomy tube dependence, were seen in 19.1% of patients with both OSA and dysphagia. Despite this, only 29.56% of dysphagic patients underwent formal swallowing assessment. Specifically, 20.53% received a videofluoroscopic swallow study (VFSS) and 1.55% underwent flexible endoscopic evaluation of swallowing (FEES). Diagnostic yield varied by modality: 77.1% of patients undergoing instrumental evaluation were diagnosed with dysphagia, compared to 29.0% with clinical evaluation alone. Dysphagia is underrecognized in patients with OSA, with most diagnoses made without formal assessment despite substantial aspiration risk. Instrumental evaluations significantly improve diagnostic accuracy but remain underutilized. These findings highlight the need for standardized, multidisciplinary screening protocols to improve the detection and management of dysphagia in the OSA population.</p>