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

Abstract

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