Comprehensive Management of Obstructive Sleep Apnea With CPAP in a Surgical Otolaryngology Practice.

Abstract

This study aims to investigate the medical management of obstructive sleep apnea (OSA) utilizing continuous positive airway pressure (CPAP) by the Otolaryngology departments within a tertiary care institution. Data was retrospectively reviewed from electronic medical records over 12 months. Patients were categorized into two cohorts based on the department managing their treatment with CPAP therapy: Otolaryngology or Sleep Medicine. Loss to follow-up was defined as the absence of a follow-up appointment within the first 12 months after prescription. Two-tailed t-tests and multivariable regression analysis were performed. Of 242 total patients included, 65 (26.9%) received CPAP from Otolaryngology and 177 (73.1%) from Sleep Medicine. Otolaryngology patients exhibited significantly higher CPAP compliance, defined as usage ≥ 4 h/night over 30 days, over the first 30 (88% vs. 47%, p < 0.001) and over the last 30 (54% vs. 37%, p = 0.031) days of usage, respectively, compared to General Sleep patients. Loss to follow-up rates did not differ between the two cohorts. Multivariable analysis found White race to be associated with higher CPAP compliance over the first 30 days (OR 6.39, 95% CI 1.29-46.5, p = 0.03). Management of CPAP by Otolaryngology was independently associated with increased CPAP compliance over the first (OR 8.02, 95% CI 3.80-19.1, p < 0.001) and last 30 days (OR 1.99, 95% CI 1.06-3.75, p = 0.032), respectively. Comprehensive management of OSA, including both medical and surgical interventions, can be successfully performed by the Otolaryngologist-Head and Neck Surgeon.