title: Outcomes for multilevel surgery for sleep apnea: Obstructive sleep apnea, transoral robotic surgery, and uvulopalatopharyngoplasty.
abstract: OBJECTIVE
  This study evaluates the outcomes of multilevel surgery for patients with obstructive sleep apnea (OSA) who underwent transoral robotic surgery (TORS) (i.e., posterior glossectomy and limited lateral pharyngectomy) with uvulopalatopharyngoplasty (UPPP).
  
  
  METHODS
  Prospective, nonrandomized trial with historical controls.
  
  
  METHODS
  All patients underwent pre- and postoperative polysomnography, preoperative magnetic resonance imaging of the neck, preoperative drug-induced sleep endoscopy, surgery, including UPPP if this had not occurred previously, and OSA TORS. Outcomes measures included apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), O2 saturation nadir, and total sleep time spent at < 90% O2 saturation.
  
  
  RESULTS
  Patients who had no prior surgery achieved an average AHI reduction from 58.4 to 19.5 (67%, P < .0001), a surgical success rate of 56%, and a surgical response rate of 73%. Patients with prior pharyngeal surgery achieved an AHI reduction from 55.0 to 45 (24%, P = .19), a surgical success rate of 30%, and a surgical response rate of 40%. Total sleep time spent at <90% O2 saturation was improved from 14% to 3.6% (P < .0003) for patients without prior surgery, and 21.1% to 12.5% (P < .17)for those with prior surgery. ESS improved for all patients combined from 12.8 to 5.8 (P < .0001).
  
  
  CONCLUSIONS
  Outcomes for the combined approach of OSA TORS and UPPP provide strong evidence in favor of this multilevel approach for the surgical management of OSA. The benefit of the current surgical approach is most significant for previously unoperated patients.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Erica R
authors.initials: ER
authors.lastname: Thaler
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Rassekh
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Weinstein
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Bert W
authors.initials: BW
authors.lastname: O'Malley
mesh_terms: D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D017286:Polysomnography; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D016896:Treatment Outcome
keywords: Obstructive sleep apnea; apnea-hypopnea index; transoral robotic surgery