Long Term Cardiovascular Outcomes Between Sleep Surgery and Continuous Positive Airway Pressure.

IF 1.3 4区医学 Q3 OTORHINOLARYNGOLOGY

Annals of Otology Rhinology and Laryngology Pub Date : 2024-12-01 Epub Date: 2024-10-22 DOI:10.1177/00034894241284169

Ann M Martin, Zachary Elliott, Eric Mastrolonardo, Richard Wu, Joshua Mease, Maurits Boon, Colin Huntley

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引用次数: 0

Abstract

Objectives: Individuals with obstructive sleep apnea (OSA) suffer from a multitude of concurrent morbidities including cardiovascular disease (CVD). Limited data exists comparing long term cardiovascular disease (CVD) clinical outcomes for patients treated with surgical intervention versus continuous positive airway pressure (CPAP). The purpose of this study was to compare CVD outcomes at multiple time points comparing those treated with sleep surgery versus CPAP alone.

Methods: A research database was used to assess outcomes: death, myocardial infarction, atrial fibrillation, heart failure, essential hypertension, and pulmonary hypertension at 5, 8, and 20 years for patients with OSA treated with surgical interventions (upper airway stimulation [UAS], uvulopalatopharyngoplasty [UPPP], and tonsillectomy) or CPAP alone. Subjects were identified using ICD and CPT codes and analyses were conducted with and without propensity score matching for age, sex, race, BMI, myocardial infarction (MI), essential hypertension, pulmonary hypertension, atrial fibrillation, and heart failure.

Results: All surgical interventions demonstrated benefit over CPAP alone at most time points for most surgical interventions. At 8 years, for all sleep surgeries (UAS or UPPP or tonsillectomy) (n = 6627) versus treatment with CPAP alone (n = 6627), matched subjects demonstrated decreased risk (odds ratios) and superior survival (hazard ratios and log ranks tests) for death (OR = 0.49 [0.39, 0.62] P ≤ .0001, HR = 0.29 [0.23, 0.37], χ² = 109.58 P ≤ .0001), myocardial infarction (OR = 0.67 [0.54, 0.84] P = .0005*, HR = 0.48 [0.38, 0.60], χ² = 42.40 P ≤ .0001), atrial fibrillation (OR = 0.70 [0.59, 0.83] P ≤ .0001, HR = 0.54 [0.45, 0.64], χ² = 51.53 P ≤ .0001), heart failure (OR = 0.55 [0.47, 0.64] P ≤ .0001, HR = 0.41 [0.35, 0.47], χ² = 137.416 P ≤ .0001), essential hypertension (OR = 0.88 [0.82, 0.94] P = .0002, HR = 0.78 [0.74, 0.82], χ² = 76.38 P ≤ .0001), and pulmonary hypertension (OR = 0.51 [0.40, 0.65] P ≤ .0001, HR = 0.38 [0.29, 0.48], χ² = 60.67 P ≤ .0001) where P ≤ .00037 indicated statistical significance*.

Conclusion: This investigation suggests surgical management of obstructive sleep apnea may contribute to the mitigation of long-term clinical CVD morbidity.

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睡眠手术与持续气道正压之间的长期心血管效果。

目标：阻塞性睡眠呼吸暂停（OSA）患者同时患有多种疾病，包括心血管疾病（CVD）。对接受手术治疗和持续气道正压（CPAP）治疗的患者进行长期心血管疾病（CVD）临床疗效比较的数据有限。本研究的目的是比较睡眠手术与单纯 CPAP 治疗患者在多个时间点的心血管疾病结果：研究数据库用于评估接受手术干预（上气道刺激[UAS]、悬雍垂腭咽成形术[UPPP]和扁桃体切除术）或单纯 CPAP 治疗的 OSA 患者在 5 年、8 年和 20 年后的结局：死亡、心肌梗死、心房颤动、心力衰竭、本质性高血压和肺动脉高压。使用 ICD 和 CPT 编码确定受试者，并对年龄、性别、种族、体重指数（BMI）、心肌梗死（MI）、原发性高血压、肺动脉高压、心房颤动和心力衰竭进行倾向得分匹配分析：在大多数手术干预的大多数时间点，所有手术干预都比单纯使用 CPAP 更有效。8 年后，所有睡眠手术（UAS 或 UPPP 或扁桃体切除术）（n = 6627）与单纯使用 CPAP 治疗（n = 6627）相比，匹配受试者的死亡风险（几率比）降低，存活率更高（危险比和对数行列检验）（OR = 0.49 [0.39, 0.62] P ≤ .0001, HR = 0.29 [0.23, 0.37], χ2 = 109.58 P ≤ .0001）、心肌梗死（OR = 0.67 [0.54, 0.84] P = .0005*, HR = 0.48 [0.38, 0.60], χ2 = 42.40 P ≤ .0001）、心房颤动（OR = 0.70 [0.59, 0.83] P≤ .0001，HR = 0.54 [0.45, 0.64]，χ2 = 51.53 P≤ .0001）、心力衰竭（OR = 0.55 [0.47, 0.64] P≤ .0001，HR = 0.41 [0.35, 0.47]，χ2 = 137.416 P≤ .0001）、原发性高血压（OR = 0.88 [0.82, 0.94] P = .0002，HR = 0.78 [0.74，0.82]，χ2 = 76.38 P≤ .0001）和肺动脉高压（OR = 0.51 [0.40，0.65] P≤ .0001，HR = 0.38 [0.29，0.48]，χ2 = 60.67 P≤ .0001），其中 P≤ .00037 表示统计学意义*：这项研究表明，对阻塞性睡眠呼吸暂停进行手术治疗有助于降低心血管疾病的长期临床发病率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Otology Rhinology and Laryngology 医学-耳鼻喉科学

CiteScore

3.10

自引率

7.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： The Annals of Otology, Rhinology & Laryngology publishes original manuscripts of clinical and research importance in otolaryngology–head and neck medicine and surgery, otology, neurotology, bronchoesophagology, laryngology, rhinology, head and neck oncology and surgery, plastic and reconstructive surgery, pediatric otolaryngology, audiology, and speech pathology. In-depth studies (supplements), papers of historical interest, and reviews of computer software and applications in otolaryngology are also published, as well as imaging, pathology, and clinicopathology studies, book reviews, and letters to the editor. AOR is the official journal of the American Broncho-Esophagological Association.