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Transoral robotic surgery for treatment of obstructive sleep apnea: Factors predicting surgical response
Author(s) -
Lin HoSheng,
Rowley James A.,
Folbe Adam J.,
Yoo George H.,
Badr M. Safwan,
Chen Wei
Publication year - 2015
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.24970
Subject(s) - medicine , obstructive sleep apnea , transoral robotic surgery , uvulopalatopharyngoplasty , epworth sleepiness scale , hypopnea , body mass index , somnolence , surgery , apnea , anesthesia , statistical significance , polysomnography , adverse effect
Objectives/Hypothesis We reviewed our experience with the use of transoral robotic surgery (TORS) for base of tongue (BOT) reduction either alone or as part of multilevel strategy in the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS) in order to identify clinical characteristics that may be associated with surgical response. Study Design Case series. Methods Between June 2010 and May 2014, BOT reduction via TORS ± partial epiglottectomy ± uvulopalatopharyngoplasty were performed on 72 patients with OSAHS. Thirty‐nine patients (15 females and 24 males) with complete preoperative and postoperative clinical information including polysomnograms were included in this study. Results Mean apnea‐hypopnea index (AHI) was 43.9 ± 32.3 preoperatively and 21.9 ± 23.5 postoperatively and reflected a statistically significant (P < 0.001) AHI reduction of 50.9% ± 38.1%. Statistical significant reduction in daytime somnolence, as measured by Epworth Sleepiness Scale (15.6 ± 5.4 preoperatively vs. 5.7 ± 4.3 postoperatively; P < 0.001), was also achieved. No statistical significant difference was found between preoperative and postoperative body mass index (BMI) (32.9 ± 7.0 vs. 32.4 ± 7.3; P = 0.270). Surgical response, as defined by > 50% reduction in AHI and final AHI < 15 with resolution of daytime somnolence, was achieved in 21 patients (53.8%). Clinical characteristics found to be significantly different between the responders and nonresponders were BMI, AHI, and lateral velopharyngeal collapse. Patients with BMI < 30, AHI < 60, or absence of lateral velopharyngeal collapse have excellent surgical response rate of 88.2%, 67.9%, or 66.7%, respectively. Conclusions We identified three clinical characteristics associated with increased surgical response rate. This finding may be useful for patient selection and counseling prior to surgery. Level of Evidence 4. Laryngoscope , 125:1013–1020, 2015