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
  1. Obstructive Sleep Apnea is characterized to a lower quality of life
  2. Multilevel Robotic surgery and CPAP treatment improve quality of life in OSA patients
  3. CPAP and TORS seems to be equally effective in terms of general quality of life improvement
  4. Greater social support is needed in patients treated with CPAP
  5. 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