Predictors of Decision to Pursue Sleep Surgery

To identify predictors of patient decision to pursue sleep apnea surgery following initial consultation with a sleep surgeon.

Retrospective cohort analysis.

Outpatient tertiary care academic center.

A retrospective review of patients with obstructive sleep apnea (OSA) diagnosis, BMI < 35 kg/m², and prior positive airway pressure (PAP) trial who were evaluated at a sleep surgery clinic. Patients who completed drug-induced sleep endoscopy (DISE) and/or surgery were compared to those who did not within at least 4 months of consultation. Surveys on OSA-related symptoms and decisional conflict were completed prior to the consultation for PAP alternatives.

Among 437 patients, 321 did not undergo DISE/surgery, whereas 116 completed DISE/surgery within an average of 16.8 months of consultation. Patients who underwent DISE/surgery had a significantly higher Epworth sleepiness scale score (10.1 ± 4.9 vs 8.5 ± 5.1, P = .006) and insomnia severity index (15.6 ± 5.5 vs 14.3 ± 5.8, P = .037) as well as significantly lower decisional conflict scale (DCS) scores (27.9 ± 21.8 vs 38.2 ± 24.9, P < .001). Multivariate analysis revealed that lower preconsultation DCS score (OR = 0.97, 95% CI [0.97, 0.99], P < .001) and lower BMI (OR = 0.91, 95% CI [0.85, 0.99], P = .019) were independently significant predictors of pursuing DISE/surgery.

Decisional conflict prior to consultation is significantly associated with completion of DISE/surgery. Those with higher decisional conflict are less likely to proceed with DISE/surgery after consultation on PAP alternatives. Effective interventions that improve patient understanding of OSA and enhance support in decision-making are needed.