Disparities in Sleep Surgery: ADI and Surgical Treatment for Obstructive Sleep Apnea

Introduction: CPAP-alternative management of obstructive sleep apnea includes hypoglossal nerve stimulator (HGNS) implantation, pharyngoplasty, maxillomandibular advancement (MMA), and Mandibular Advancement Devices (MAD). It is unclear if there are socioeconomic disparities in management. This study uses the Area Deprivation Index (ADI) to evaluate the role of socioeconomic status in patient decision-making and treatment selection.

Methods: Demographic data, treatment intervention, and ADI were collected. Welch’s Anova and Kruskal-Wallis tests evaluated ADI differences across treatment groups. Multinomial logistic regression models were performed to determine ADI’s influence on treatment selection.

Results: 470 patients were included (mean age 54 ± 14.9; 69.7% male; 65% White; AHI 33.7 ± 24.8; ADI 39.7 ± 21.3). Mean ADI by treatment: HGNS 41.6, MMA 39.4, ESP 36.7, MAD 42.8, other 36.6. Welch’s ANOVA and Kruskal–Wallis tests showed no significant ADI differences across treatment groups. Multinomial regression found no independent association between ADI and treatment selection after adjusting for gender and ethnicity. When adjusting for race, higher ADI demonstrated greater odds of pursuing HGNS (OR 1.01; p< 0.05), while Black/African American patients had lower odds of selecting MMA (OR 0.03; p< 0.05).

Conclusions: While socioeconomic status via the ADI was not significantly associated with treatment selection, racial differences in pursuit of MMA surgery and higher HGNS use among higher ADI patients suggest possible variance in treatment selection. Further evaluation of the role of socioeconomic status in patient decision-making is needed.