Effects of surgery and CPAP on cardiovascular health in patients with obstructive sleep apnea

This study aimed to assess and compare the risks of cardiovascular disease and mortality in individuals with obstructive sleep apnea (OSA) undergoing treatment with either continuous positive airway pressure (CPAP) or upper airway surgery (UAS). Using the TriNetX database, we identified 1,477,746 OSA patients between 2014 and 2019. In total 3638 matched pairs of patients were selected, based on their propensity scores, with one group having received UAS and the other having received CPAP therapy. The Cox proportional hazards models were used to compare the risk of major adverse cardiovascular events (MACEs) between the two groups. Subgroup analyses based on age, sex, race, and BMI categories were conducted to validate the findings. After propensity score matching, the UAS group had significantly lower risks of all-cause mortality (HR 0.45; 95% CI 0.33–0.59) and MACEs (HR 0.61; 95% CI 0.49–0.75) compared to the CPAP group. Subgroup analyses revealed that both male and female patients treated with UAS were associated with lower risks of all-cause mortality and MACEs. White individuals and those with BMI < 30 or ≥ 30, with age < 65 in the UAS group, consistently exhibited lower risks of all-cause mortality and MACEs. Patients with OSA receiving UAS were associated with lower risks of all-cause mortality and MACEs compared to those on CPAP. Subgroup analyses revealed variations in benefits, with lower risks of mortality and MACEs observed across different genders, age groups, racial backgrounds, and BMI categories within the UAS-treated population.