Mean disease alleviation between surgery and CPAP in matched adults with obstructive sleep apnea.

Abstract

Polysomnography parameters measure treatment efficacy for obstructive sleep apnea, such as reduction in apnea hypopnea index. However, for continuous positive airway pressure (CPAP) therapy, polysomnography measures do not factor in adherence and thus do not measure effectiveness. Mean disease alleviation (MDA) corrects polysomnography measures for CPAP adherence and was used to compare treatment effectiveness between CPAP and multilevel upper airway surgery. This retrospective cohort study consisted of a consecutive sample of 331 patients with obstructive sleep apnea managed with multilevel airway surgery as second line treatment (N=97) or CPAP (N=234). Therapeutic effectiveness (MDA as % change or as corrected change in apnea hypopnea index) was calculated as the product of therapeutic efficacy (% or absolute change in apnea hypopnea index) and adherence (% time on CPAP of average nightly sleep). Cardinality and propensity score matching was utilised to manage confounding variables. Surgery patients achieved greater MDA % than CPAP users (67 ± 30% vs. 60 ± 28%, p=0.04, difference 7 ± 3%, 95% confidence interval 4% to 14%) in an unmatched comparison, despite a lower therapeutic efficacy seen with surgery. Cardinality matching demonstrated comparable MDA % in surgery (64%) and CPAP (57%) groups (p=0.14, difference 8 ± 5%, 95% confidence interval -18% to 3%). MDA measured as corrected change in apnea hypopnea index showed similar results. In adult patients with obstructive sleep apnea, multilevel upper airway surgery and CPAP provide comparable therapeutic effectiveness on polysomnography. For patients with inadequate CPAP use, surgery should be considered.