Supplementary Material for: Impact of Ambient Air Pollution on Obstructive Sleep Apnea Surgery: A Longitudinal Study

Introduction: Obstructive sleep apnea (OSA) is a worldwide health concern having been proved to be associated with air pollution. However, it remains unclear whether air pollution could also compromise the effect of OSA treatment, especially OSA surgery. This study investigated the impact of mid- to long-term ambient air pollution exposure on postsurgical outcomes of OSA patients.
Methods: 382 OSA patients who had failed conservative treatment first and received OSA surgery afterwards were enrolled; the patients were then categorized into the severely (192 patients; 50.3%) and mildly (190 patients; 49.7%) air-polluted group based on the calculated average exposure of air particles according to the report of Taiwan Ministry of Environment. The relationships among the airborne particles and sleep indices changes were analyzed for determining the impact of air pollution on OSA surgery.
Results: After a mid- to long-term exposure following OSA surgery, the results of the follow-up polysomnography showed that ΔAHI, ΔLSAT, and Δarousal index were significantly different between the two air-polluted groups. Pearson’s correlations revealed that the above sleep indices were significantly yet weakly associated with air quality index (AQI), SO2, NO2, CO, and O3. After adjusting the confounding factors, the multivariate analysis showed that different air pollution levels still had statistically significant influence on Δarousal index (β=-0.105, p=.045).
Conclusion: Despite the effectiveness of OSA surgery, mid- to long-term exposure to ambient air pollution postoperatively may still have statistically significant association on OSA patients’ postsurgical outcomes, and thus could not be overlooked.