Outcomes of CPAP and uvulopalatopharyngoplasty in obstructive sleep apnea: a retrospective cohort study

Introduction: Obstructive sleep apnea (OSA) is an increasingly prevalent disorder that can lead to significant morbidity and reduced quality of life. Continuous positive airway pressure (CPAP) is the current gold standard treatment, but its long-term adherence remains suboptimal, thus many patients benefit from surgical alternatives such as uvulopalatopharyngoplasty (UPPP). This study compares the short- and long-term clinical outcomes following CPAP or UPPP treatment for OSA, including their impacts on OSA-related comorbidities such as respiratory failure, cardiac disease, and T2DM.

Methods: A retrospective cohort analysis utilizing TriNetX datasets from 2014 through 2024 compared outcomes of two cohorts of adult (≥18 years) patients: OSA patients treated with CPAP (n=2450) and OSA patients treated with UPPP (n=220). The populations were matched for demographics and various comorbidities, with 190 patients in each cohort.

Results: The CPAP cohort had a significantly higher odds of acute respiratory failure (OR 3.38, [1.60,7.12]) and new onset atrial fibrillation/flutter (OR 4.27, [1.90,9.57) as compared to the UPPP cohort. In the first 9 months post-therapy, the UPPP group had higher A1c levels; however, beyond 9 months post-therapy, the UPPP group had significantly lower A1c levels compared to the CPAP group (p=0.0003). There were no significant differences between the two groups in new onset type 2 diabetes, heart attack or stroke prevalence.

Conclusions: Patients treated with CPAP for OSA had higher odds of acute respiratory failure and new-onset atrial fibrillation/flutter, while UPPP was associated with improved long-term glycemic control despite initially higher A1c levels. These findings suggest that UPPP is not an inferior modality compared to CPAP and may improve long term glycemic control and cardiopulmonary morbidity related to OSA.