title: Transoral robotic surgery for treatment of obstructive sleep apnea: factors predicting surgical response.
abstract: OBJECTIVE
  We reviewed our experience with the use of transoral robotic surgery (TORS) for base of tongue (BOT) reduction either alone or as part of multilevel strategy in the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS) in order to identify clinical characteristics that may be associated with surgical response.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Between June 2010 and May 2014, BOT reduction via TORS ± partial epiglottectomy ± uvulopalatopharyngoplasty were performed on 72 patients with OSAHS. Thirty-nine patients (15 females and 24 males) with complete preoperative and postoperative clinical information including polysomnograms were included in this study.
  
  
  RESULTS
  Mean apnea-hypopnea index (AHI) was 43.9 ± 32.3 preoperatively and 21.9 ± 23.5 postoperatively and reflected a statistically significant (P < 0.001) AHI reduction of 50.9% ± 38.1%. Statistical significant reduction in daytime somnolence, as measured by Epworth Sleepiness Scale (15.6 ± 5.4 preoperatively vs. 5.7 ± 4.3 postoperatively; P < 0.001), was also achieved. No statistical significant difference was found between preoperative and postoperative body mass index (BMI) (32.9 ± 7.0 vs. 32.4 ± 7.3; P = 0.270). Surgical response, as defined by > 50% reduction in AHI and final AHI < 15 with resolution of daytime somnolence, was achieved in 21 patients (53.8%). Clinical characteristics found to be significantly different between the responders and nonresponders were BMI, AHI, and lateral velopharyngeal collapse. Patients with BMI < 30, AHI < 60, or absence of lateral velopharyngeal collapse have excellent surgical response rate of 88.2%, 67.9%, or 66.7%, respectively.
  
  
  CONCLUSIONS
  We identified three clinical characteristics associated with increased surgical response rate. This finding may be useful for patient selection and counseling prior to surgery.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Wayne State University and Karmanos Cancer Institute, Detroit, Michigan, U.S.A; Department of Surgery, Wayne State University, Detroit, Michigan, U.S.A.
authors.forename: Ho-Sheng
authors.initials: HS
authors.lastname: Lin
authors.forename: James A
authors.initials: JA
authors.lastname: Rowley
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Folbe
authors.forename: George H
authors.initials: GH
authors.lastname: Yoo
authors.forename: M Safwan
authors.initials: MS
authors.lastname: Badr
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005927:Glossectomy / Q000379:methods*; D005931:Glottis / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation / Q000379:methods*; D017286:Polysomnography / Q000379:methods; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D065287:Robotic Surgical Procedures / Q000379:methods*; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Obstructive sleep apnea/hypopnea syndrome; base of tongue reduction; epiglottectomy; glossectomy; robot-assisted; robotic surgery; sleep apnea; sleep apnea surgery; tongue base; transoral robotic surgery