Quality of Life and Excessive Daytime Sleepiness in Adults with Obstructive Sleep Apnea Who Are Treated with Multilevel Surgery or Adherent to Continuous Positive Airway Pressure

Giannicola Iannella; Giuseppe Magliulo; Cristina Anna Maria Lo Iacono; Irene Claudia Visconti; Jerome R Lechien; Tiziano Perrone; Giovanni Cammaroto; Giuseppe Meccariello; Antonino Maniaci; Salvatore Cocuzza; Milena Di Luca; Andrea De Vito; Chiara Martone; Antonella Polimeni; Antonio Greco; Marco de Vincentiis; Massimo Ralli; Annalisa Pace; Giampiero Gulotta; Stefano Pelucchi; Angelo Eplite; Claudio Vicini

doi:10.3390/jcm11092375

Quality of Life and Excessive Daytime Sleepiness in Adults with Obstructive Sleep Apnea Who Are Treated with Multilevel Surgery or Adherent to Continuous Positive Airway Pressure

J Clin Med. 2022 Apr 23;11(9):2375. doi: 10.3390/jcm11092375.

Authors

Giannicola Iannella^{1

2}, Giuseppe Magliulo², Cristina Anna Maria Lo Iacono³, Irene Claudia Visconti², Jerome R Lechien⁴, Tiziano Perrone⁵, Giovanni Cammaroto¹, Giuseppe Meccariello¹, Antonino Maniaci⁶, Salvatore Cocuzza⁶, Milena Di Luca⁶, Andrea De Vito⁷, Chiara Martone⁷, Antonella Polimeni², Antonio Greco², Marco de Vincentiis², Massimo Ralli², Annalisa Pace², Giampiero Gulotta², Stefano Pelucchi⁴, Angelo Eplite⁸, Claudio Vicini^{1

5}

Affiliations

¹ Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy.
² Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185 Rome, Italy.
³ Department of Cardiovascular, Respiratory, Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University, Viale dell'Università, 33, 00185 Rome, Italy.
⁴ Laboratory of Anatomy and Cell Biology, Faculty of Medicine, University of Mons (UMONS), Avenue du Champ de Mars, 6, B7000 Mons, Belgium.
⁵ Department ENT & Audiology, University of Ferrara, Via Savonarola, 9, 44121 Ferrara, Italy.
⁶ Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Via S. Sofia, 78, 95125 Catania, Italy.
⁷ Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Ospedale "Santa Maria delle Croci", Viale Vincenzo Randi, 5, 48121 Ravenna, Italy.
⁸ ENT Department, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy.

Abstract

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 (p = 0.4). General benefit score showed no difference between groups (p = 0.1). Better values of social status benefit (p = 0.0006) emerged in the CPAP Group, whereas greater physical status benefit (p = 0.04) was shown in the TORS Group. Delta-AHI (-23.7 ± 14.3 vs. -31.7 ± 15.6; p = 0.001) and Delta-ODI (-24.5 ± 9.5 vs. -29.4 ± 10.5; p = 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 (p = 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.

Keywords: CPAP; Obstructive Sleep Apnea; quality of life; robotic surgery; sleep studies.