Survival of veterans with sleep apnea: Continuous positive airway pressure versus surgery☆
Presented at the Annual Meeting of the American Academy of Otolaryngology–Head and Neck Surgery, Orlando, FL, September 21-24, 2003.
Abstract
Objectives
Continuous positive airway pressure (CPAP) improves sleep apnea survival. We tested whether CPAP is associated with better survival than uvulopalatopharyngoplasty (UPPP).
Study design and methods
This retrospective cohort database study included all sleep apnea patients treated with CPAP or UPPP in Veteran Affairs facilities from October 1997 through September 2001. Treatment groups were compared with Cox regression, adjusting for age, gender, race, year treatment was initiated, and comorbidity. Sleep apnea severity and CPAP use data were not available.
Results
By September 2002, 1339 (7.1%) of 18,754 CPAP patients and 71 (3.4%) of 2,072 UPPP patients were dead (P < 0.001). After adjustment, CPAP patients had 31% (95% confidence interval, 3% to 67%, P = 0.03) higher probability of being dead at any time, relative to UPPP patients.
Conclusions
UPPP confers a survival advantage over CPAP, after adjustment for age, gender, race, year of treatment, and comorbidity. However, we were unable to adjust for sleep apnea severity or CPAP use. Surgical treatment should be considered in sleep apnea patients who use CPAP inadequately.
aSurgery and Perioperative Care (Otolaryngology) Service (Drs Weaver and Yueh), Seattle, WA USA
bHealth Services Research and Development Service (Drs Maynard and Yueh), Seattle, WA, USA
cEpidemiologic Research and Information Center (Dr Maynard), Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
dDepartment of Otolaryngology–Head and Neck Surgery (Drs Weaver and Yueh), Seattle, WA, USA
eSleep Disorders Center (Dr Weaver), Seattle, WA, USA
fCenter for Cost and Outcomes Research (Dr Weaver), Seattle, WA, USA
gDepartment of Health Services (Drs Maynard and Yueh), University of Washington, Seattle, WA, USA
Reprint requests: Edward M. Weaver, VA PSHCS 112-OTO, 1660 S Columbian Way, Seattle, WA 98108, USA
☆ This study was supported by a Seattle Veterans Affairs Epidemiologic Research and Information Center pilot grant. Dr Weaver is supported by a Career Development Award (HL068849) from the National Heart, Lung, and Blood Institute and by a Career Development Scholars Award from the American Geriatrics Society. Dr Yueh is supported by a Career Development Award (CD-98318) from the Health Services Research and Development Service of the Veterans Health Administration, Department of Veterans Affairs.
The views expressed in this article are those of the authors and do not necessarily represent the views of the Health Services Research and Development Service or Surgery and Perioperative Care Service of the Veterans Health Administration, Department of Veterans Affairs.
ABSTRACT