Iannella Giannicola, Magliulo Giuseppe, Lo Iacono Cristina Anna Maria, Visconti Irene Claudia, Lechien Jerome R, Perrone Tiziano, Cammaroto Giovanni, Meccariello Giuseppe, Maniaci Antonino, Cocuzza Salvatore, Di Luca Milena, De Vito Andrea, Martone Chiara, Polimeni Antonella, Greco Antonio, de Vincentiis Marco, Ralli Massimo, Pace Annalisa, Gulotta Giampiero, Pelucchi Stefano, Eplite Angelo, Vicini Claudio
Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy.
Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185 Rome, Italy.
J Clin Med. 2022 Apr 23;11(9):2375. doi: 10.3390/jcm11092375.
Obstructive Sleep Apnea (OSA) syndrome is a respiratory sleep disorder characterized by a reduction (hypopnea) in or a complete cessation (apnea) of airflow in the upper airways at night, in the presence of breathing effort. The gold standard treatment for OSA is ventilation through continuous positive airway pressure (CPAP), although this often shows poor patient compliance. In recent years, transoral robotic surgery (TORS) has been proposed as a valid surgical treatment for patients suffering from OSA in a multilevel surgical setting. The aim of this study is to analyze the effects on QoL and daytime sleepiness of multilevel surgery for OSA (barbed pharyngoplasty + transoral robotic surgery). Furthermore, we compared the impact on QoL and daytime sleepiness of two different treatments for patients with moderate to severe OSA, such as CPAP and TORS. Sixty-seven OSA patients who underwent multilevel robotic surgery and sixty-seven OSA patients treated with CPAP were enrolled, defined as Group 1 and Group 2, respectively. The Glasgow Benefit Inventory (GBI) questionnaire was administrated to evaluate the changes in the QoL. Respiratory outcomes were evaluated and compared. Group 1 showed a GBI total average value of +30.4, whereas Group 2, a value of +33.2 ( = 0.4). General benefit score showed no difference between groups ( = 0.1). Better values of social status benefit ( = 0.0006) emerged in the CPAP Group, whereas greater physical status benefit ( = 0.04) was shown in the TORS Group. Delta-AHI (-23.7 ± 14.3 vs. -31.7 ± 15.6; = 0.001) and Delta-ODI (-24.5 ± 9.5 vs. -29.4 ± 10.5; = 0.001) showed better values in the CPAP group. Therapeutic success rate of the Multilevel TORS Group was 73.1% and 91% in the CPAP group ( = 0.01), respectively. Multilevel TORS and CPAP have a positive effect on the quality of life of OSA patients. Greater social support has been reported in the CPAP group and better physical health status in the TORS group. No statistical difference emerged in the reduction in daytime sleepiness between both groups.
阻塞性睡眠呼吸暂停（OSA）综合征是一种睡眠呼吸障碍，其特征是夜间上呼吸道气流减少（呼吸浅慢）或完全停止（呼吸暂停），同时存在呼吸努力。OSA的金标准治疗方法是通过持续气道正压通气（CPAP）进行通气，尽管这种方法患者的依从性往往较差。近年来，经口机器人手术（TORS）已被提议作为一种在多级手术环境中治疗OSA患者的有效手术方法。本研究的目的是分析OSA多级手术（倒刺咽成形术+经口机器人手术）对生活质量（QoL）和日间嗜睡的影响。此外，我们比较了两种不同治疗方法（如CPAP和TORS）对中重度OSA患者QoL和日间嗜睡的影响。招募了67例行多级机器人手术的OSA患者和67例接受CPAP治疗的OSA患者，分别定义为第1组和第2组。采用格拉斯哥获益量表（GBI）问卷评估QoL的变化。对呼吸结果进行评估和比较。第1组的GBI总平均值为+30.4，而第2组为+33.2（P=0.4）。总体获益评分在两组之间无差异（P=0.1）。CPAP组的社会地位获益值更好（P=0.0006），而TORS组的身体状况获益更大（P=0.04）。CPAP组的Delta-AHI（-23.7±14.3 vs.-31.7±15.6；P=0.001）和Delta-ODI（-24.5±9.5 vs.-29.4±10.5；P=0.001）显示出更好的值。多级TORS组的治疗成功率为73.1%，CPAP组为91%（P=0.01）。多级TORS和CPAP对OSA患者的生活质量有积极影响。CPAP组报告的社会支持更大，TORS组的身体健康状况更好。两组在日间嗜睡减少方面没有统计学差异。
