The Rise of Upper Airway Stimulation in the Era of Transoral Robotic Surgery for Obstructive Sleep Apnea

Abstract This study compared the characteristic surgical parameters and clinical effects of transoral robotic surgery (TORS) and other available methods used to alleviate obstructive sleep apnea. Articles on TORS and other surgeries for obstructive sleep apnea were identified in the PubMed and EMBASE databases. Two investigators independently reviewed the articles and classified the data for meta-analysis. The pooled effect sizes of TORS (standardized mean difference; SMD = − 2.38), coblation tongue base resection (CTBR; SMD = − 2.00) and upper airway stimulation (UAS; SMD = − 0.94) revealed significant improvement in the apnea–hypopnea index (AHI; p < 0.05). The lowest O2 saturation reported was significantly increased following TORS (SMD = 1.43), CTBR (SMD = 0.86) and UAS (SMD = 1.24, p < 0.05). Furthermore, TORS (SMD = − 2.91) and CTBR (SMD = − 1.51, p < 0.05) significantly reduced the Epworth Sleepiness Scale (ESS) score. No significant difference in operation time, success rate, or instances of complication were observed between TORS and the other compared interventions. The use of TORS in obstructive sleep apnea has the same rate of success and failure as other methods of surgical intervention for obstructive sleep apnea with no statistical difference in operation times. The reported clinical effects on the AHI, lowest O2 saturation, and ESS scores of TORS were similar to those of other surgeries.

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0671 Combination Of Transoral Robotic Surgery And Oropharyngeal Myofunctional Therapeutic Training For Patients With Obstructive Sleep Apnea

SLEEP ◽

10.1093/sleep/zsaa056.667 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A256-A256

Author(s):

Y J Lai ◽

C H Hung ◽

C Y Lin

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Robotic Surgery ◽

Upper Airway ◽

Transoral Robotic Surgery ◽

University Hospital ◽

Apnea Hypopnea Index ◽

Tongue Protrusion ◽

Jaw Opening ◽

Obstructive Sleep

Abstract Introduction Obstructive Sleep Apnea (OSA) is a type of sleep disorder characterized by intermittent, partial or complete upper airway collapse. Mostly, moderate to severe OSA cases were recommended to treat with continuous positive airway pressure, however, some of them were withdrawn. Transoral robotic surgery (TORS) was considered for OSA patient with tongue base hypertrophy, but the success rate was only 66.9% and the symptoms might relapse because of aging and gaining weights. Myofunctional therapeutic training (MFTT) was also an alternative treatment for patients with mild to moderate OSA. In our study, we investigated the effect of TORS surgery and oropharyngeal MFTT for OSA patients. Methods Seven adult patients were recruited, who were newly diagnosed with moderate to severe OSA (Apnea-hypopnea Index, AHI, 49.8±27.7/h). Polysomnography, questionnaire (Pittsburgh sleep quality index, PSQI; Snore Outcomes Survey, SOS), and the muscle strengths over tongue and jaw-opening were assessed before TORS surgery, 6-week and 18-week after surgery. The components of MFTT program involved jaw opening, tongue protrusion, tongue left, tongue right, tongue up and tongue down. It began at 6th week after surgery and these patients underwent 12 weeks of the home-based oropharyngeal MFTT. During the training intervention period, subjects were interviewed every week for adjusting the treatment intensity. Results Mean age was 45.9 years old (SD 9.8) and body mass index (BMI) was 26.6 (SD 3.6). After combination treatment of TORS surgery and MFTT, AHI-supine was significantly decreased from 66.3/h to 26.8/h (p<0.05). PSQI and SOS scores were significantly improved (-2.1, 28.8, respectively). Compared with different components of MFTT program, muscle strength of tongue protrusion was the only significant predictor of AHI-supine reduction. Conclusion Our study presented that combination of TORS surgery and oropharyngeal MFTT could improve OSA severity and symptoms. Support This work was supported by National Cheng-Kung University Hospital (grant number NCKUH-10802018).

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TransOral Robotic Surgery (TORS) for Obstructive Sleep Apnea Syndrome

Nihon Kikan Shokudoka Gakkai Kaiho ◽

10.2468/jbes.67.124 ◽

2016 ◽

Vol 67 (2) ◽

pp. 124-124

Author(s):

Scott Magnuson

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Robotic Surgery ◽

Obstructive Sleep Apnea Syndrome ◽

Sleep Apnea Syndrome ◽

Transoral Robotic Surgery ◽

Obstructive Sleep ◽

Apnea Syndrome

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Upper Airway Stimulation Therapy for Obstructive Sleep Apnea

10.1093/med/9780197521625.001.0001 ◽

2021 ◽

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Upper Airway ◽

Novel Therapy ◽

Upper Airway Stimulation ◽

Current State ◽

Obstructive Sleep ◽

Long Term Follow Up ◽

Physician Extenders ◽

Primary Care Practitioners

Upper Airway Stimulation Therapy for Obstructive Sleep Apnea provides the current state of knowledge regarding this novel therapy. It reviews the pathophysiologic basis of sleep apnea and the specific mechanism by which upper airway stimulation provides airway support in this disorder. It also provides practical insights into this therapy related to patient selection, clinical outcomes, surgical technique, long-term follow-up, and adverse events and offers recommendations for those aspiring to develop an upper airway stimulation program. It provides an overview of unique populations and circumstances that may extend the utility of the procedure, and that may provide challenges in management, as well as thoughts on the future of this technology. This textbook is intended for all practitioners who have interest or care for sleep disordered breathing, including sleep medicine physicians, pulmonologists, otolaryngologists, primary care practitioners, as well as physician extenders.

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