OBJECTIVES/HYPOTHESIS: This study evaluates the outcomes of multilevel surgery for patients with obstructive sleep apnea (OSA) who underwent transoral robotic surgery (TORS) (i.e., posterior glossectomy and limited lateral pharyngectomy) with uvulopalatopharyngoplasty (UPPP). STUDY DESIGN: Prospective, nonrandomized trial with historical controls. METHODS: All patients underwent pre- and postoperative polysomnography, preoperative magnetic resonance imaging of the neck, preoperative drug-induced sleep endoscopy, surgery, including UPPP if this had not occurred previously, and OSA TORS. Outcomes measures included apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), O2 saturation nadir, and total sleep time spent at < 90% O2 saturation. RESULTS: Patients who had no prior surgery achieved an average AHI reduction from 58.4 to 19.5 (67%, P < .0001), a surgical success rate of 56%, and a surgical response rate of 73%. Patients with prior pharyngeal surgery achieved an AHI reduction from 55.0 to 45 (24%, P = .19), a surgical success rate of 30%, and a surgical response rate of 40%. Total sleep time spent at <90% O2 saturation was improved from 14% to 3.6% (P < .0003) for patients without prior surgery, and 21.1% to 12.5% (P < .17)for those with prior surgery. ESS improved for all patients combined from 12.8 to 5.8 (P < .0001). CONCLUSIONS: Outcomes for the combined approach of OSA TORS and UPPP provide strong evidence in favor of this multilevel approach for the surgical management of OSA. The benefit of the current surgical approach is most significant for previously unoperated patients.
OBJECTIVES/HYPOTHESIS: This study evaluates the outcomes of multilevel surgery for patients with obstructive sleep apnea (OSA) who underwent transoral robotic surgery (TORS) (i.e., posterior glossectomy and limited lateral pharyngectomy) with uvulopalatopharyngoplasty (UPPP). STUDY DESIGN: Prospective, nonrandomized trial with historical controls. METHODS: All patients underwent pre- and postoperative polysomnography, preoperative magnetic resonance imaging of the neck, preoperative drug-induced sleep endoscopy, surgery, including UPPP if this had not occurred previously, and OSA TORS. Outcomes measures included apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), O2 saturation nadir, and total sleep time spent at < 90% O2 saturation. RESULTS:Patients who had no prior surgery achieved an average AHI reduction from 58.4 to 19.5 (67%, P < .0001), a surgical success rate of 56%, and a surgical response rate of 73%. Patients with prior pharyngeal surgery achieved an AHI reduction from 55.0 to 45 (24%, P = .19), a surgical success rate of 30%, and a surgical response rate of 40%. Total sleep time spent at <90% O2 saturation was improved from 14% to 3.6% (P < .0003) for patients without prior surgery, and 21.1% to 12.5% (P < .17)for those with prior surgery. ESS improved for all patients combined from 12.8 to 5.8 (P < .0001). CONCLUSIONS: Outcomes for the combined approach of OSA TORS and UPPP provide strong evidence in favor of this multilevel approach for the surgical management of OSA. The benefit of the current surgical approach is most significant for previously unoperated patients.
Authors: Giannicola Iannella; Giuseppe Magliulo; Cristina Anna Maria Lo Iacono; Irene Claudia Visconti; Jerome R Lechien; Tiziano Perrone; Giovanni Cammaroto; Giuseppe Meccariello; Antonino Maniaci; Salvatore Cocuzza; Milena Di Luca; Andrea De Vito; Chiara Martone; Antonella Polimeni; Antonio Greco; Marco de Vincentiis; Massimo Ralli; Annalisa Pace; Giampiero Gulotta; Stefano Pelucchi; Angelo Eplite; Claudio Vicini Journal: J Clin Med Date: 2022-04-23 Impact factor: 4.964
Authors: David Kent; Jeffrey Stanley; R Nisha Aurora; Corinna G Levine; Daniel J Gottlieb; Matthew D Spann; Carlos A Torre; Katherine Green; Christopher G Harrod Journal: J Clin Sleep Med Date: 2021-12-01 Impact factor: 4.062