CPAP and palatal surgery cohorts were matched for demographics and comorbidities.

CPAP was associated with increased odds of acute respiratory failure and atrial arrhythmias.

Palatal surgery showed lower long-term recorded pulmonary hypertension rates.

Surgical patients demonstrated lower mean weight beyond 9 months post-intervention.

To compare short- and long-term clinical outcomes of continuous positive airway pressure versus palatal surgical interventions such as uvulopalatopharyngoplasty, including their impacts on sleep apnea-related cardiac, respiratory, and metabolic comorbidities.

Retrospective cohort study.

Database study using the TriNetX Network of Tennessee (2014–2024).

Adult patients diagnosed with obstructive sleep apnea and treated with either continuous positive airway pressure or palatal surgery were identified. Propensity score matching was performed to balance demographics and preexisting comorbidities between groups. Primary outcomes were cardiopulmonary events, and secondary outcomes were new-onset type 2 diabetes and weight change. Odds ratio with 95 % confidence intervals were computed across outcome measures.

A total of 5030 continuous positive airway pressure and 220 palatal surgery patients met inclusion criteria. Following matching, 220 patients remained in each group. Patients treated with continuous positive airway pressure had significantly higher odds of post-treatment electronic medical record coding of acute respiratory failure (OR 4.67, [2.27, 9.60]), pulmonary hypertension (OR 20.0, [2.71, 147.7]), and new-onset atrial fibrillation/flutter (OR 3.32, [1.60, 6.96]) compared to the surgical cohort. No significant differences were observed in myocardial infarction, stroke, or new-onset type 2 diabetes.

Patients treated with continuous positive airway pressure had higher odds of post-treatment electronic medical recording coding of cardiorespiratory complications than those undergoing palatal surgery. These findings highlight potentially important differences between treatment modalities in long-term obstructive sleep apnea related comorbidities.

Obstructive sleep apnea (OSA)

Continuous positive airway pressure (CPAP)

Palatal surgery

Uvulopalatopharyngoplasty (UPPP)

Sleep surgery

© 2025 The Authors. Published by Elsevier Inc.