Abstract Introduction Since the widespread adoption of telemedicine (TM) as a reimbursable option for the delivery of healthcare, (particularly clinic visits), the field of sleep medicine has been a beneficiary. In complex neurological patients, it was hypothesized that physical and cognitive constraints would limit the use of TM. This analysis was undertaken to evaluate patient care strategies in an academic neurology department based in a large metropolitan city Methods 2964 adult patients who opted for neurology clinic visits via video TM in the last 6 months were included from electronic medical record review at the University of Texas Health Sciences Center in Houston. Of these, 557 were seen in sleep medicine specialty. A successful visit was defined as a simultaneous connection of at least 2 parties for a minimum duration of time defined by institutional guidelines. Patients were analyzed in age subgroups (< 30, 31-50, 51-70 and >70 years of age) as well as race (Asian, Black, Hispanic, White and Others). Neurological diagnoses in these patients included stroke, epilepsy, movement disorders, cognitive disorders, neuromuscular conditions and less commonly multiple sclerosis Results Sleep medicine providers comprise of 2/53 (3.7%) of the department’s clinical providers, but accounted for 18.7% of TM visits. 97% (182/186) of new patients and 95% (354/371) of established patients had successful TM visits. Among general neurology patients, these numbers were 89% and 88% respectively. There was a statistically significant difference between successful visits in the sleep medicine and overall neurology patient groups (p value 0.0003 for new, 0.0001 for established patients). Among sleep medicine patients, percentage failures were 2.9, 3.3, 4.1 and 3.9 among the respective age groups. Percentage failures across the respective racial groups were 0, 6.1, 4.8, 4.2 and 1.9. Reasons cited for unsuccessful visits included camera, microphone and general hardware failures. Surprisingly network failure was not reported Conclusion The success of telemedicine clinic visits for the management of sleep disorders is not impacted by physical and cognitive impairment in patients with complex neurological conditions. Further analysis to include success of sleep diagnostics and treatment of sleep disorders (start-to-finish pathway), via telemedicine in this complex population is underway Support (if any) None