Uvulopalatopharyngoplasty reduces the incidence of cardiovascular complications caused by obstructive sleep apnea: results from the national insurance service survey 2007–2014

Lee, Heung Man; Kim, Hyo Yeol; Suh, Jeffrey D.; Han, Kyung Do; Kim, Jin Kook; Lim, Young Chang; Hong, Seokchan; Cho, Jae Hoon

doi:10.1016/j.sleep.2017.12.019

Cited by 34 publications

(55 citation statements)

References 19 publications

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“…This finding may represent strong evidence that UPPP has a clinical effect independent of AHI‐based judgment. A considerable strength of this study is that long‐term follow‐up was conducted across large‐scale patient groups using national insurance data . Large‐scale studies are essential to determine the deleterious effect of OSA on the incidence of depression and preventive effect of UPPP .…”

Section: Discussionmentioning

confidence: 99%

“…A considerable strength of this study is that long‐term follow‐up was conducted across large‐scale patient groups using national insurance data . Large‐scale studies are essential to determine the deleterious effect of OSA on the incidence of depression and preventive effect of UPPP . Recently, Ishman et al reported that the Beck depression index decreased after surgery in patients with OSA .…”

Section: Discussionmentioning

confidence: 99%

“…The NHIS is a national insurer managed by the Korean government, which covers 97% of the Korean population . Both outpatient and inpatient claims are reviewed by the NHIS, and these include data on diagnoses, procedures, prescription records, demographic information, and direct medical costs.…”

Section: Methodsmentioning

confidence: 99%

“…Data are presented as mean ± standard deviation for age and as proportions for the remaining categorical variables. The Kaplan‐Meier plot without covariance correction was presented to analyze the risk of depression according to the presence or absence of OSA and whether the patient underwent UPPP . The incidence rate of depression was calculated by dividing the number of events by the person‐time at risk.…”

Section: Methodsmentioning

confidence: 99%

“…The incidence rate of depression was calculated by dividing the number of events by the person‐time at risk. To determine the hazard ratio (HR) of OSA on the incidence of depression, the Cox proportional hazards model was used after stratifying for covariates, including age, sex, income level, diabetes, hypertension, and dyslipidemia . Two models were used: Model 1 was adjusted by age and sex.…”

Section: Methodsmentioning

confidence: 99%

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Uvulopalatopharyngoplasty reduces the incidence of depression caused by obstructive sleep apnea

et al. 2018

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Objective To investigate the increase in the incidence of depression in patients with obstructive sleep apnea (OSA) and its preventability by uvulopalatopharyngoplasty (UPPP). Methods In this retrospective cohort study, data from the Korea National Health Insurance Corporation were analyzed. A total of 160,840 participants (age ≥ 20 years) who were newly diagnosed with OSA between 2007 and 2014 were included. The participants were classified into a group that underwent UPPP (UPPP group, n = 19,773) and a group that did not undergo surgical treatment (no surgery group, n = 141,067). Propensity score matching by age and sex was used to select the control group of 804,200 subjects. The mean follow‐up duration was 4.6 ± 2.3 years. The primary endpoint was newly diagnosed depression. Results The incidence of depression was higher in patients with OSA than in controls (hazard ratio [HR]: 1.678, 95% confidence interval [CI]: 1.650–1.706). The UPPP group was still at a higher risk of depression than was the control group (HR: 1.535, 95% CI: 1.463–1.610), but the HR was statistically lower than that in the no surgery group (HR: 1.694, 95% CI: 1.665–1.724). Conclusion OSA increases the incidence of depression, which may be prevented to some extent by UPPP. Level of Evidence 2b Laryngoscope, 129:1005–1009, 2019

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Uvulopalatopharyngoplasty reduces the incidence of depression caused by obstructive sleep apnea

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The Effect of Surgical Treatment on Obstructive Sleep Apnea—Reply

MacKay

McEvoy

Weaver

2021

JAMA

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Association of Systemic Diseases With Surgical Treatment for Obstructive Sleep Apnea Compared With Continuous Positive Airway Pressure

Ibrahim

Mendonca

Gombar³

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEThe efficacy of surgical treatments for obstructive sleep apnea (OSA) is variable when considering only the Apnea Hypopnea Index as the treatment end point. However, only a few studies have shown an association between these procedures and improved clinically relevant outcomes, such as cardiovascular, endocrine, and neurological sequelae of OSA.OBJECTIVE To evaluate the association of surgery for OSA with clinically relevant outcomes. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study used the Truven MarketScan Database from January 1, 2007, to December 31, 2015, to identify all patients diagnosed with OSA who received a prescription of continuous positive airway pressure (CPAP), were 40 to 89 years of age, and had at least 3 years of data on file. Data were analyzed September 19, 2019.INTERVENTIONS Soft tissue and skeletal surgical procedures for the treatment of OSA. MAIN OUTCOMES AND MEASURESThe occurrence of cardiovascular, neurological, and endocrine complications was compared in patients who received CPAP alone and those who received surgery. High-dimensionality propensity score matching was used to adjust the models for confounders. Kaplan-Meier survival analysis with a log-rank test was used to compare differences in survival curves. FINDINGS A total of 54 224 patients were identified (33 405 men [61.6%]; mean [SD] age, 55.1 [9.2] years), including a cohort of 49 823 patients who received CPAP prescription alone (mean [SD] age, 55.5 [9.4] years) and 4269 patients who underwent soft tissue surgery (mean [SD] age, 50.3 [7.0] years). The median follow-up time was 4.47 (interquartile range, 3-8) years after the index CPAP prescription.In the unadjusted model, soft tissue surgery was associated with decreased cardiovascular (hazard ratio [HR], 0.92; 95% CI, 0.86-0.98), neurological (HR, 0.49; 95% CI, 0.39-0.61), and endocrine (HR, 0.80; 95% CI, 0.74-0.86) events. This finding was maintained in the adjusted model (HR for cardiovascular events, 0.91 [95% CI, 0.83-1.00]; HR for neurological events, 0.67 [95% CI, 0.51-0.89]; HR for endocrine events, 0.82 [95% CI, 0.74-0.91]). Skeletal surgery (n = 114) and concomitant skeletal and soft tissue surgery (n = 18) did not demonstrate significant differences in rates of development of systemic complications. CONCLUSIONS AND RELEVANCEIn this cohort study, soft tissue surgery for OSA was associated with lower rates of development of cardiovascular, neurological, and endocrine systemic complications compared with CPAP prescription in a large convenience sample of the working insured US adult population. These findings suggest that surgery should be part of the early treatment algorithm in patients at high risk of CPAP failure or nonadherence.

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Uvulopalatopharyngoplasty reduces the incidence of cardiovascular complications caused by obstructive sleep apnea: results from the national insurance service survey 2007–2014

Cited by 34 publications

References 19 publications

Uvulopalatopharyngoplasty reduces the incidence of depression caused by obstructive sleep apnea

Uvulopalatopharyngoplasty reduces the incidence of depression caused by obstructive sleep apnea

The Effect of Surgical Treatment on Obstructive Sleep Apnea—Reply

Association of Systemic Diseases With Surgical Treatment for Obstructive Sleep Apnea Compared With Continuous Positive Airway Pressure

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