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

Introduction: Patients with Obstructive Sleep Apnea (OSA) have a higher risk of Motor Vehicle Accidents (MVAs). While this association is well-documented, few studies have examined the effectiveness of common treatment modalities in reducing the risk of MVAs. Our study seeks to evaluate and compare the incidence of MVAs among OSA patients undergoing Continuous Positive Airway Pressure (CPAP) therapy and surgical intervention to further characterize the personal and public health implications of OSA.

Methods: The TriNetX national clinical database was queried for the incidence of MVAs among OSA patients, specifically comparing cohorts with OSA (ICD-10: G47.33) undergoing CPAP therapy (CPT: 94660), sleep surgery (CPT: 1007178, 42145, 64568), and patients without these treatments. Sleep surgery procedures included uvulopalatopharyngoplasty, tonsillectomy and adenoidectomy, and upper airway stimulation devices. 1:1 Propensity score matching (PSM) was utilized to ensure comparability between cohorts for the covariates of age, gender, race, and BMI. Statistical analysis was performed to assess MVA incidence and post-MVA survival probabilities across cohorts.

Results: A total of 2,486,486 patients with OSA were identified and propensity score matched into comparison cohorts. Patients with OSA who underwent sleep surgery demonstrated a reduced risk of MVA (Risk: 0.032) compared to patients with OSA not on treatment (OR: 1.072, p = 0.004). When compared to patients using CPAP, patients in the sleep surgery cohort also had a reduced risk of MVA (Risk: 0.036; OR: 1.48, p < 0.0001).

Conclusions: Our findings suggest that sleep surgery techniques are an appropriate treatment to reduce the risk of MVAs in patients with OSA when compared to both CPAP therapy and untreated OSA. In appropriate candidates, surgery should be considered as an intervention to help reduce the public health impact of preventable accidents.