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

The majority of the current literature assessing OSA utilizes change in AHI as the outcome measure. Clinical effectiveness of therapy is influenced by treatment adherence. Mean disease alleviation (MDA) was designed to determine the effectiveness of treatment as a function of both treatment efficacy and adherence. Our study compares outcomes in OSA patients treated with transoral robotic surgery (TORS) with lingual tonsillectomy and hypoglossal nerve stimulation (HGNS) using MDA.

A retrospective study of CPAP-intolerant OSA patients that underwent HGNS or TORS from 2015 to 2022 was conducted. Comparisons of MDA and treatment efficacy were performed using a Wilcoxon sum rank tests after 3:1 matching for race, age, sex, body mass index, and baseline AHI. Statistical significance was defined as P < .05.

One hundred fifty-nine patients (127 HGNS and 32 TORS) were included. Mean AHI decreased postoperatively in both TORS and HGNS patients (P < .001). There was no difference in AHI reduction between TORS and HGNS patients (22.95 ± 21.99 vs 23.27 ± 15.28; P = .50). This relationship persisted when examining MDA between TORS and HGNS patients (41.56 ± 58.24 vs 51.46 ± 29.05; P = .40).

Mean disease alleviation is a useful metric combining both adherence and efficacy to determine the effectiveness of OSA treatments expanding beyond AHI. Our data suggests that the clinical effectiveness of TORS and HGNS is comparable, and both are promising treatment options for well-selected OSA patient's refractory to CPAP.