Risk of Motor Vehicle Accidents in Obstructive Sleep Apnea: Comparative Analysis of CPAP Versus Surgery.

Objective: To compare the incidence of motor vehicle accidents (MVAs) among patients with obstructive sleep apnea (OSA) undergoing continuous positive airway pressure (CPAP) therapy and sleep surgery.

Study design: Retrospective cohort study using the TriNetX national clinical database.

Setting: Analysis of a nationwide patient cohort.

Methods: The database was queried for patients with OSA (International Classification of Diseases, 10th Revision: G47.33) treated with CPAP (Current Procedural Terminology [CPT]: 94660), sleep surgery (CPT: 42145, 64568, 64582), or no treatment. Sleep surgeries included uvulopalatopharyngoplasty and hypoglossal nerve stimulation. 1:1 Propensity score matching (PSM) ensured cohort comparability by age, sex, and race. MVA incidence rates were analyzed, along with a subanalysis of OSA-related comorbidities as a surrogate of OSA severity.

Results: A total of 2,832,437 patients with OSA were identified. Patients with OSA undergoing sleep surgery demonstrated a significantly lower incidence of MVAs (3.403%) compared to the OSA + CPAP cohort (6.072%) and the no-treatment group (4.662%). The odds ratio (OR) for MVA incidence in the no-treatment group compared to the OSA + sleep surgery cohort was 1.214 (95% confidence interval [CI]: 1.060-1.391, P = .0051). The OR in the OSA + sleep surgery cohort compared to the CPAP cohort was 0.545 (95% CI: 0.480-0.618, P < .0001). Patients with OSA who experienced MVAs were more likely to have comorbidities such as hypertension, diabetes, and heart failure following the accident.

Conclusion: Sleep surgery significantly reduces the risk of MVAs in patients with OSA compared to CPAP and no treatment. In appropriate candidates, surgery should be considered to mitigate personal and public health risks associated with OSA.