Surgical treatment for OSA tied to lower rates of CV, endocrine, neurological complications

Soft tissue surgery for obstructive sleep apnea was associated with lower risk for cardiovascular, neurological and endocrine systemic complications compared with CPAP in a large cohort of U.S. adults, researchers reported.

“The variable efficacy of various surgical procedures to improve the apnea-hypopnea index, snoring and sleepiness has been well demonstrated in prior studies,” Badr Ibrahim, MD, otolaryngologist in the division of sleep surgery, department of otolaryngology-head and neck surgery, Stanford University School of Medicine, Stanford Hospital and Clinics, and colleagues wrote in JAMA Otolaryngology-Head & Neck Surgery. “However, only a few studies to date have focused on the relevance of surgical procedures for mortality and health-related outcomes, including fatal and nonfatal cardiovascular events and neurocognitive and endocrine ailments.”

The retrospective cohort study included 54,224 patients (mean age, 55.1 years; 61.6% men) diagnosed with OSA. All were participants from the Truven MarketScan Database from 2007 to 2015 who received a prescription for CPAP and had at least 3 years of data on record. Th researchers evaluated the association of surgery for OSA with clinically relevant outcomes in 4,269 patients who underwent soft tissue surgery (mean age, 50.3 years; 32.3% women) compared with 49,823 patients who received CPAP alone (mean age, 55.5 years; 38.9% women).

Median follow-up for all patients was 4.47 years after the index CPAP prescription.

The researchers reported clinically meaningful reductions in CV (HR = 0.92; 95% CI, 0.86-0.98), neurological (HR = 0.49; 95% CI, 0.39-0.61) and endocrine (HR = 0.8; 95% CI, 0.74-0.86) events after soft tissue surgery in an unadjusted model. The reductions for all CV (HR = 0.91; 95% CI, 0.83-1), neurological (HR = 0.67; 95% CI, 0.51-0.89) and endocrine (HR = 0.82; 95% CI, 0.74-0.91) events were maintained in a model adjusted for confounders.

There were no significant differences in rates of development of systemic complications among patients who underwent skeletal surgery and concomitant skeletal and soft tissue surgery for treatment of OSA.

“[These results] expand on the findings of an emerging body of literature evaluating clinically meaningful health-related outcomes,” the researchers wrote. “Further observational and experimental studies focusing on similar outcomes are needed to critically assess the value of surgical interventions in the treatment of OSA and establish causality.”