Transoral robotic base of tongue reduction for obstructive sleep apnea: A systematic review and meta-analysis

Abstract

Objectives/hypothesis: To determine the effect of transoral robotic surgery (TORS) base of tongue (BOT) reduction on sleep-related outcomes in patients with obstructive sleep apnea (OSA).

Data sources: PubMed, Scopus, EMBASE, CINAHL, Cochrane, and Ovid.

Review methods: Literature search by two independent authors was conducted using the abovementioned databases. Studies on TORS BOT reduction as part of OSA treatment in adult patients with pre- and postoperative apnea-hypopnea index (AHI) scores were included. Studies on TORS as treatment for diseases other than OSA were excluded.

Results: A total of six articles with 353 patients treated with TORS BOT reduction met inclusion criteria. Pooled analyses (baseline vs. postsurgery) showed significant improvement in the following: AHI (44.3 ± 22.4 to 17.8 ± 16.5, P < .01), Epworth Sleepiness Scale (12.9 ± 5.4 to 5.8 ± 3.7, P < .01), lowest oxygen saturation (79.0 ± 9.5 to 84.1 ± 6.5, P < .01), and snoring visual analog scale (9.3 ± 0.8 to 2.4 ± 2.43, P < .01). Surgical success rate, defined as a >50% reduction of AHI with a postoperative AHI < 20, was 68.4% (95% confidence interval [CI] = 63.0%-73.5%). Cure rate (postoperative AHI < 5) was 23.8% (95% CI = 19.1%-29.2%).

Conclusions: TORS BOT reduction decreases AHI and symptoms of sleepiness in adult patients with OSA. It is considered successful in a majority of cases; however, further studies must be performed to optimize patient selection criteria to achieve higher rates of success. Laryngoscope, 127:258-265, 2017.

Keywords: Transoral robotic surgery; base of tongue; glossectomy; lingual tonsillectomy; obstructive sleep apnea; sleep surgery.