Transoral robotic surgery versus upper airway stimulation in select obstructive sleep apnea patients

Transoral robotic surgery (TORS) has been used to treat obstructive sleep apnea (OSA) since 2009, with recent meta-analysis showing an average reduction of apnea-hypopnea index (AHI) from 44.3 to 17.0. In 2014, upper airway stimulation surgery (UAS) was approved for OSA treatment, with results showing an average AHI reduction from 32.0 to 15.3. Given there was a period when TORS was available and UAS was not, we looked at a subset of patients treated with TORS but who could have qualified for UAS and compared their outcomes to patients who received UAS.

This is a retrospective chart review comparing TORS to UAS in treatment of OSA performed by a single surgeon between 2011 and 2016. Inclusion criteria were a body mass index less than 35 and AHI between 20 and 65 consistent with criteria for UAS implantation. Patients who received TORS and met the inclusion criteria had their preoperative drug-induced sleep endoscopy recordings re-evaluated. Patients with anteroposterior retropalatal collapse that would have qualified them for UAS had their outcomes compared to patients who received UAS.

Results between TORS and UAS showed an average AHI reduction of 12.7 and 33.3, respectively. Overall cure rate, defined as AHI < 5, was 10.0% and 70.3%, respectively.

Results of this study indicate that, when met with criteria for both TORS and UAS, patients receiving UAS had greater improvement in several objective measures of OSA. Studies like this may help direct future treatment algorithms for surgical management of OSA.

4 Laryngoscope, 129:256-258, 2019.