How do you counsel and manage patients who meet criteria for sleep apnea based on 3% but not 4% desaturation?

It depends on the patient's symptoms. If they have symptoms attributable to sleep apnea then I tell them they have sleep apnea. If they don't have symptoms then I don't diagnose them with sleep apnea.

If the patient has an insurance plan that only accepts 4% desaturations and yet they clearly have sleep apnea symptoms and with the 3% criteria have OSA, I treat them with CPAP. In this situation, the CPAP would be either a donated machine or a machine that the patient can purchase at a low price from an online retailer.

At least one DME provider in my area will sell a refurbished Airsense 10 machine and have the patient also take a best-fitting mask for $250.00.

Even qualifying patients with high copays or deductibles may take advantage of this.