title: Addressing the Retrolingual Space in Obstructive Sleep Apnea: Outcomes Stratified by Friedman Stage in Patients Undergoing Transoral Robotic Surgery.
abstract: OBJECTIVE
  To stratify outcomes in patients with moderate to severe obstructive sleep apnea-hypopnea syndrome (OSAHS) undergoing transoral robotic surgery (TORS) ± multilevel procedures according to Friedman stage.
  
  
  METHODS
  A total of 118 patients with moderate to severe OSAHS between 2010 and 2013 were stratified preoperatively by Friedman stage. All patients had TORS-assisted lingual tonsillectomy, either stand-alone or in combination with palatal surgery. Apnea-hypopnea index (AHI) was measured preoperatively and 3 months postoperatively. Success was defined as a decrease in AHI by 50% and AHI <20.
  
  
  RESULTS
  The average pre- and postoperative AHI was 43.0 and 22.6, respectively, and the overall success rate was 63%. When stratifying by Friedman stage, success was seen in 75% of stage I, 70% of stage II, 66% of stage III, and 10% of stage IV patients. When stratifying by preoperative BMI, success was seen in 75% of stage II and 72% of stage III patients with BMI <30, compared to 58% of stage II and 56% of stage III patients with BMI >30.
  
  
  CONCLUSIONS
  TORS-assisted lingual tonsillectomy ± multilevel procedures can be successful in treating patients with moderate to severe OSAHS with Friedman stage I-III anatomy. Success rates are even greater if patients are stratified according to preoperative BMI, as those with BMI <30 are more likely to achieve success even with Friedman stage II-III anatomy.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Mich., USA.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Spector
authors.forename: Tiffany A
authors.initials: TA
authors.lastname: Glazer
authors.forename: Paul T
authors.initials: PT
authors.lastname: Hoff
mesh_terms: D015992:Body Mass Index; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000033:anatomy & histology*; D013517:Otorhinolaryngologic Surgical Procedures; D065287:Robotic Surgical Procedures; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000145:classification* / Q000601:surgery*; D016896:Treatment Outcome