Comparing Transoral Robotic Surgery and Hypoglossal Nerve Stimulation Using Mean Disease Alleviation in OSA

Area of Science:

• Sleep Medicine
• Surgical Innovation
• Obstructive Sleep Apnea Treatment

Background:

• Current obstructive sleep apnea (OSA) research often relies on apnea-hypopnea index (AHI) changes.
• Treatment effectiveness depends on both adherence and efficacy.
• Mean disease alleviation (MDA) integrates adherence and efficacy for a holistic assessment.

Purpose of the Study:

• To compare the clinical effectiveness of transoral robotic surgery (TORS) and hypoglossal nerve stimulation (HGNS) in CPAP-intolerant OSA patients.
• To evaluate treatment outcomes using Mean Disease Alleviation (MDA).

Main Methods:

• Retrospective analysis of 159 CPAP-intolerant OSA patients treated with HGNS (127) or TORS (32) between 2015-2022.
• 3:1 matching based on race, age, sex, BMI, and baseline AHI.
• Statistical comparison of MDA and AHI reduction using Wilcoxon rank-sum tests (P < .05 significance).

Main Results:

• Both TORS and HGNS significantly reduced postoperative AHI (P < .001).
• No significant difference in AHI reduction between TORS and HGNS (P = .50).
• No significant difference in MDA between TORS and HGNS (P = .40).

Conclusions:

• MDA is a valuable metric for evaluating OSA treatment effectiveness, incorporating adherence and efficacy.
• TORS and HGNS demonstrate comparable clinical effectiveness in this patient cohort.
• Both TORS and HGNS represent promising therapeutic options for select OSA patients resistant to CPAP.