Sleep Apnea Patients Picking CPAP Over Surgery Could Increase Risk of Car Accidents, Study Finds

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A new study suggests people with sleep apnea opting to keep their CPAP machines instead of undergoing sleep surgery could increase their risk of motor vehicle accidents.
A study of more than 2.8 million patients with obstructive sleep apnea (OSA), suggests those who underwent sleep surgery instead of using continuous positive airway pressure machines—better known as CPAP—cut the odds of experiencing a motor vehicle accident by more than 20%.

“Our findings underscore the profound impact that inadequately managed obstructive sleep apnea can have on individual health and public safety,” said corresponding author Elliott M. Sina, BA, a medical student at the Sidney Kimmel Medical College at Thomas Jefferson University. “This work adds to the growing body of evidence supporting surgical interventions such as hypoglossal nerve stimulation as an effective alternative treatment for select patients with obstructive sleep apnea.”

Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repeated interruptions in breathing during sleep due to the temporary collapse or blockage of the upper airway. These interruptions, known as apneas, can last for several seconds and often occur multiple times per hour. Symptoms of OSA may include loud snoring, gasping for air during sleep, excessive daytime fatigue, and difficulty concentrating. Left untreated, OSA can contribute to serious health issues such as high blood pressure, heart disease, and an increased risk of stroke.

Invented in 1980 by an Australian physician, continuous positive airway pressure CPAP machines have become a mainstay in the management of obstructive sleep apnea. According to data published in 2023, more than 8 million CPAP machines are sold annually in the US alone. CPAP machines provide relief for people with OSA by delivering a steady stream of pressurized air through a mask worn over the nose or mouth, keeping the airway open during sleep. By preventing airway collapse, CPAP can help restore normal breathing, improving sleep quality and reducing the risk of complications associated with untreated OSA.

However, since the introduction of CPAP advances in sleep surgery have significantly expanded treatment options for OSA, particularly for patients who struggle with or cannot tolerate CPAP therapy. Procedures such as upper airway stimulation (UAS) therapy, which uses an implantable device to activate muscles and keep the airway open during sleep, offer innovative alternatives, and hypoglossal nerve stimulation, a minimally invasive treatment that uses an implantable device to stimulate the hypoglossal nerve and control tongue movement, have become increasingly popular.

In the current study, Sina and a team of physicians at Thomas Jefferson University used data from a major database—the TriNetX Global Collaborative Network, consisting of 101 contributing healthcare organizations and 125 million patients. The specific aim of the study was 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.

To improve the accuracy of their analysis, investigators matched patients in a 1:1 ratio based on age, sex, and race. The primary outcome of interest for the study team was motor vehicle accident incident rates based on treatment received, with groups defined as no treatment, CPAP, sleep surgery, and CPAP plus sleep surgery. The team also planned a subanalysis of OSA-related comorbidities as a surrogate of OSA severity.

Results showed people who had sleep surgery had fewer motor vehicle accidents (3.4%) compared to those using CPAP machines (6.1%) and those who didn’t receive treatment (4.7%). Compared to those who had surgery, untreated individuals were about 21% more likely to get into an accident. Further underscoring this finding in support of sleep surgery were data indicating those using CPAP machines were 45% more likely to have an accident than those who had surgery.

“These findings suggest that sleep surgery techniques are an appropriate treatment for those unable to tolerate and comply with CPAP. Sleep surgery may reduce the risk of [motor vehicle accidents] in patients with OSA when compared to both CPAP therapy and untreated OSA,” wrote Sina and colleagues. “In appropriate candidates, surgery should be considered as an intervention to help reduce the public health impact of preventable accidents.”