(Table 4).
DISCUSSION
Few papers in literature have investigated the improvement on quality of
life after OSA treatments (19,20), therefore limited data about this
topic are available in literature. Turner et al (21), have observed a
statistically significance improvement (p<0.04), in terms of
working memory, long-term memory, quality of life and positive attitude
after CPAP treatment. In a meta-analysis study Kuhn et al.(19) proved,
using the SF 36 questionnaire, a positive effect of CPAP treatment on
the HR-QoL of patients with OSA.
Despite these published evidences, no studies in literature have
analyzed QoL after multilevel robotic surgery for OSA and no authors
have compared multilevel surgery and CPAP therapy in QoL improvement of
OSA patients.
In the surgical treated patients of our study a GBI total average value
of +30.4 emerged with a maximum of +75.0 and a minimum value of -16.7.
The general benefit score was calculated as +31.3 (range -63.8 to
+88.3), and the social benefit was +11.5 (range 0 to +66.7), whereas the
physical score resulted to be +24.8 (range -16.7 to +50). These positive
values over +20 points indicate an effective improvement in all aspects
of the Qol.
Patients treated with CPAP showed an excellent improvement in quality of
life as well (+38.6 range -20.3 to +100). However, despite a higher mean
value of the total GBI in this second group, no statistical differences
emerged in the total GBI score (Overall Benefit) with patients surgical
treated. These results could be explained by the good clinical and
respiratory outcomes obtained in both treatments analyzed(22); a
significative difference between pre-treatment and post-treatment AHI
values (p=0.0001) was observed in both groups of patients. Probably for
the same reason, by comparing the two groups of study a
not-statistically significant difference was likewise found in the
general partial score (p= 0.1). Similar results have been described by
Robinson et al.(23). They, in a clinical study, did not observe a
statistically significant difference between CPAP and Upper Airway
Surgery (UAS) in terms of general quality of life (p=0.308).
In terms of social subscale, we reported higher values in CPAP group
(mean 26.9) than in TORS-multilevel surgery (mean 11.6), with a
statistical difference (p= 0.0006). This subscale investigates the
social support in terms of the help provided by relatives and friends in
the management of daily life, in relation to the pathology and the
proposed therapy. This explains the possible reason why the TORS group
has reported significantly lower values in this subscale. In fact,
patients treated with C-PAP require more attention in managing the
disease, the related symptoms and the device itself. Therefore, they
probably need more care and support from their friends and relatives.
The physical score analyzes the benefit in physical health status
including frequency of illness, need of medicament or medical consult.
Regarding the scores of this subscale, statistical difference emerged
between groups with higher values in the TORS group (mean 24.8) than in
the CPAP group (mean 18.7 p<0.04). In case of surgical
success(24), multilevel surgery could lead to a reduction of medical
necessities and consults. Contrarily, patients that use the CPAP need
constant device setting and medical consults. Furthermore, this device
is characterized by poor mask comfort with a sense of pressure during
the night. These aspects should not be underestimated, as they could be
the cause of a poorer physical score reported in CPAP patients than in
TORS subjects(25).
Although important results about the impact of CPAP and TORS on quality
of life and its aspects have emerged, this study has some limitations
such as its retrospective nature and the not extensive number of
patients enrolled. Moreover, surgically treated patients require a
longer follow-up to confirm these statements, while the mean follow up
of 1.4 year described in this study is large but not sufficient to have
definitive results. Further prospective large-series studies are
underway to validate these outcomes.
CONCLUSIONS
Multilevel surgery and CPAP treatment have a positive impact in the
quality of life in OSA patients. Both therapies appear to be equally
effective in the improvement of the general quality of life (total and
general GBI scores), without statistical differences among them. Data
show a greater social support in patients treated with CPAP, while
patients undergoing robotic multilevel surgery report a greater
improvement in their physical health status.
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