ABSTRACT
Objectives: The aim of this study has been to analyze effects
on Quality of Life (QoL) of the multilevel surgery for Obstructive Sleep
Apnea (OSA). Also, we have compared the impact on QoL of two different
treatments for patients with moderate to severe OSA such as CPAP and
transoral robotic surgery (TORS).
Design: 67 OSA patients who underwent multilevel robotic
surgery and 67 OSA patients treated with CPAP were enrolled in a Group 1
and Group 2 respectively. The Glasgow Benefit Inventory (GBI)
questionnaire has been administrated to all patients to evaluate the
changes in the QoL after the different OSA treatment. Respiratory
outcomes pre and post treatment were evaluated and compared.
Results: Group 1 showed a GBI total average value of +30.4,
whereas the group 2 a value of +33.2 . No statistical difference emerged
(p=0.4). General benefit score showed no difference between groups (p =
0.1). Better values of social status benefit (p= 0.0006) emerged in CPAP
Group, whereas greater physical status benefit (p=0.04) was showed in
TORS Group. Delta-AHI (-23.7 ± 14.3 vs -31.7 ± 15.6; p = 0.001),
Delta-ODI (-24.5 ± 9.5 vs. -29.4 ±10.5; p = 0.001) showed better values
in CPAP group. Therapeutic success rate of Multilevel TORS Group was
73.1% and 91% in CPAP group (p = 0.01) respectively.
Conclusion : Multilevel TORS and CPAP have a positive effect in
quality of life of OSA patients. Greater social support has been
reported in CPAP group and better physical health status in TORS group.
Keywords: Robotic surgery, CPAP, OSAS, Quality-of-Life,
sleep-questionnaire
KEYPOINTS
- Obstructive Sleep Apnea is characterized to a lower quality of life
- Multilevel Robotic surgery and CPAP treatment improve quality of life
in OSA patients
- CPAP and TORS seems to be equally effective in terms of general
quality of life improvement
- Greater social support is needed in patients treated with CPAP
- Better physical health status has been demonstrated in patients
underwent multilevel TORS
-
INTRODUCTION
Obstructive Sleep Apnea (OSA) syndrome is a respiratory sleep disorder
characterized by a reduction (hypopnea) or complete cessation (apnea) of
airflow in the upper airways during night, in the presence of breathing
effort (1–3).
The available literature suggests that OSA, in untreated adults, is
associated with a poor health-related quality of life (HRQoL), probably
due to symptoms and complications related to this disease.(4,5)
Continuous Positive Air Pressure (CPAP) is considered the gold standard
treatment for severe OSA and has been shown to be effective in reducing
the apnea-hypopnea index (AHI), improving sleep quality [3] and
decreasing cardiovascular comorbidities. (6). Besides, it has been
proven that CPAP treatment, by restoring the sleep quality and OSA
symptoms, is directly correlated to an improvement in the quality of
life (QoL) of these patients.
Over the years different types of surgeries of the velo-pharyngeal
region and/or on the tongue base, as an alternative to the ventilatory
therapy, have been proposed. Trans- Oral- Robotic- Surgery (TORS)
allows, in selected cases of OSA patients, the muscular and lymphatic
resection of the tongue base, increasing the respiratory space and
stabilizing the collapse of this anatomical region. In the last years,
many papers have confirmed the efficacy of TORS, performing it as a
single level surgery or as part of multilevel surgery (7–11).
Surgical treatment in OSAS patients has some important benefits
(12–14). These include the possible resolution of the apneas/hypopneas,
which allows patients to avoid the use of devices during the night.
Besides, most side effects of CPAP therapy (pressure effect of the mask,
poor compliance, etc.), could be avoided with surgery.
How is the post-operative quality of life of patients surgically treated
with TORS? Could there be differences between CPAP and multilevel
surgery in the post-operative quality of life of OSA patients?
To our knowledge, no studies in literature have evaluated patient’s
quality of life after surgical treatment for OSA with a multilevel
surgery including TORS. Besides, no studies have compared changes in
patient’s quality of life of surgical and non-surgical OSA treatments.
The aim of this study has been to analyze effects on QoL of the
multilevel surgery for OSA. Also, we have compared the impact on QoL of
two different treatments for patients with moderate to severe OSA such
as CPAP and TORS.
MATERIALS AND METHODS