scholarly journals Comparison of transoral robotic surgery with other surgeries for obstructive sleep apnea

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yung-An Tsou ◽  
Wen-Dien Chang
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Robotic Surgery ◽  
Operation Time ◽  
Transoral Robotic Surgery ◽  
Apnea Hypopnea Index ◽  
Clinical Effects ◽  
Upper Airway Stimulation ◽  
Obstructive Sleep ◽  
Significant Difference

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.

scholarly journals Effect of Upper Airway Stimulation in Patients with Obstructive Sleep Apnea (EFFECT): A Randomized Controlled Crossover Trial

2021 ◽  
Vol 10 (13) ◽  
pp. 2880
Author(s):  
Clemens Heiser ◽  
Armin Steffen ◽  
Benedikt Hofauer ◽  
Reena Mehra ◽  
Patrick J. Strollo ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Crossover Trial ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Upper Airway Stimulation ◽  
Sham Stimulation ◽  
Randomized Controlled ◽  
Obstructive Sleep ◽  
Significant Difference

Background: Several single-arm prospective studies have demonstrated the safety and effectiveness of upper airway stimulation (UAS) for obstructive sleep apnea. There is limited evidence from randomized, controlled trials of the therapy benefit in terms of OSA burden and its symptoms. Methods: We conducted a multicenter, double-blinded, randomized, sham-controlled, crossover trial to examine the effect of therapeutic stimulation (Stim) versus sham stimulation (Sham) on the apnea-hypopnea index (AHI) and the Epworth Sleepiness Scale (ESS). We also examined the Functional Outcomes of Sleep Questionnaire (FOSQ) on sleep architecture. We analyzed crossover outcome measures after two weeks using repeated measures models controlling for treatment order. Results: The study randomized 89 participants 1:1 to Stim (45) versus Sham (44). After one week, the AHI response rate was 76.7% with Stim and 29.5% with Sham, a difference of 47.2% (95% CI: 24.4 to 64.9, p < 0.001) between the two groups. Similarly, ESS was 7.5 ± 4.9 with Stim and 12.0 ± 4.3 with Sham, with a significant difference of 4.6 (95% CI: 3.1 to 6.1) between the two groups. The crossover phase showed no carryover effect. Among 86 participants who completed both phases, the treatment difference between Stim vs. Sham for AHI was −15.5 (95% CI −18.3 to −12.8), for ESS it was −3.3 (95% CI −4.4 to −2.2), and for FOSQ it was 2.1 (95% CI 1.4 to 2.8). UAS effectively treated both REM and NREM sleep disordered breathing. Conclusions: In comparison with sham stimulation, therapeutic UAS reduced OSA severity, sleepiness symptoms, and improved quality of life among participants with moderate-to-severe OSA.

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

SLEEP ◽  
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&lt;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).

Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction

ORL ◽  
2021 ◽  
pp. 1-8
Author(s):  
Lifeng Li ◽  
Demin Han ◽  
Hongrui Zang ◽  
Nyall R. London
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nasal Obstruction ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Nasal Surgery ◽  
Subjective Sleep Quality ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
The Impact

<b><i>Objective:</i></b> The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. <b><i>Methods:</i></b> Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. <b><i>Results:</i></b> By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (<i>p</i> &#x3c; 0.05), while the Apnea-Hypopnea Index (AHI) changed little (<i>p</i> = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all <i>p</i> &#x3c; 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (<i>p</i> &#x3c; 0.05), except with the AHI (<i>p</i> &#x3e; 0.05). <b><i>Conclusion:</i></b> Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.

scholarly journals Clinical and Polysomnographic Characteristics of Patients with Extreme Obstructive Sleep Apnea, AHI > 100: A Case-Control Study

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Forogh Soltaninejad ◽  
Negarsadat Neshat ◽  
Mehrzad Salmasi ◽  
Babak Amra
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Study Results ◽  
Significant Difference ◽  
Severe Manifestation ◽  
The Mean ◽  
Nocturnal Polysomnography ◽  
Control Study

Background: Severe obstructive sleep apnea (OSA), defined by apnea-hypopnea index (AHI) as more than 30 events per hour, was previously related to more comorbidity. However, limited studies separated the patients with AHI > 100 from those with a less severe manifestation of the disease. Objectives: The current study aimed at describing the characteristics of this subgroup and comparing them with less severe conditions. Methods: A retrospective analysis was conducted on 114 patients with OSA. Nocturnal polysomnography was used to diagnose severe OSA. Patients were categorized into two groups: (1) 60 < AHI < 100 (very severe OSA), (2) AHI ≥ 100 (extreme OSA). Demographic, medical history, and polysomnographic variables were evaluated and compared between the two groups. Results: Extreme OSA was diagnosed in 19 patients, the mean body mass index (BMI) was significantly higher in this group (39.26 ± 5.93 vs. 35.68 ± 6.45 kg/m2, P = 0.025). They also had lower minimal O2 saturation (65.68 ± 10.16 vs. 74.10 ± 8.74, P = 0.003) and more time with < 90% O2 saturation (T < 90%) (81.78 ± 22.57 vs. 58.87 ± 33.14, P = 0.01). OHS prevalence was significantly higher in the group with extreme OSA (P = 0.04). The most frequent comorbidity was hypertension, with an incidence of 60.5%, for the extreme group, although there was no significant difference between the two groups in terms of clinical associations. Conclusions: The current study results suggested that greater BMI and lower minimal O2 saturation, as well as increased T < 90%, were associated with extreme OSA, although no differences were observed in the associated diseases between the compared groups.

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