Sleep Surgery for Obstructive Sleep Apnea Lowers Risk for Car Accidents

Compared with individuals using continuous positive airway pressure (CPAP) therapy or receiving no treatment, those with obstructive sleep apnea (OSA) who undergo sleep surgery have a lower risk for motor vehicle accidents (MVAs), according to a study published in Otolaryngology–Head and Neck Surgery.

Researchers conducted a retrospective cohort study using the TriNetX national clinical database to compare the incidence of MVAs among patients with OSA treated with CPAP, sleep surgery, or no intervention. Individuals diagnosed with OSA were categorized into 3 groups: those treated with CPAP, those who underwent sleep surgery (including uvulopalatopharyngoplasty and hypoglossal nerve stimulation), and those who received no treatment. Propensity score matching (1:1) was conducted based on age, sex, and race.

The primary outcome was the incidence of MVAs, while a secondary analysis examined the presence of OSA-related comorbidities.

Out of 2,832,437 patients diagnosed with OSA, 702,189 were matched and included in both the CPAP and no-treatment groups for analysis while the sleep surgery cohort consisted of 11,578 patients.

The incidence of MVAs was highest among CPAP users (6.072%), followed by the untreated OSA group (4.662%), and was lowest among those who underwent sleep surgery (3.403%).

When compared to individuals who underwent sleep surgery, those with untreated OSA had a higher risk for MVAs (odds ratio [OR], 1.214; 95% CI, 1.060-1.391; P =.0051). Relative to sleep surgery patients, CPAP users had a significantly lower risk for MVAs (OR, 0.545; 95% CI, 0.480-0.618; P <.0001).

Patients with OSA who were involved in an MVA were found to have higher rates of comorbidities including:

• hypertension (58.8% vs 45.4%; OR, 0.582; 95% CI, 0.577-0.588; P <.0001),
• diabetes (33.8% vs 24.2%; OR, 0.626; 95% CI, 0.620-0.632), and
• heart failure (19.5% vs 11.7%; OR, 0.546; 95% CI, 0.540-0.552).

Despite CPAP therapy being the standard treatment for OSA, patient adherence remains a challenge, with up to 83% of individuals reporting difficulty maintaining regular use due to discomfort and inconvenience. While CPAP therapy has been shown to reduce crash risk in compliant users, the findings suggest that sleep surgery may offer a more effective long-term solution, as it does not rely on daily adherence.

Study limitations included the inability to assess CPAP compliance, potential selection bias in surgical patients, and the reliance on medical records for MVA incidence, which may not capture all accidents.

“These findings suggest that sleep surgery techniques are an appropriate treatment for those unable to tolerate and comply with CPAP,” the researchers wrote. They concluded, “In appropriate candidates, surgery should be considered as an intervention to help reduce the public health impact of preventable accidents.”

Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.