(1300) A Comparison of Mean Disease Alleviation in Obstructive Sleep Apnea: Transoral Robotic Surgery Versus Upper Airway Stimulation

Introduction: Current obstructive sleep apnea (OSA) literature focuses on treatment efficacy defined as the reduction in apnea-hypopnea index (AHI) compared to baseline. Clinical effectiveness of therapy and measurements of efficacy are greatly influenced by adherence to treatment options. Mean disease alleviation (MDA) was designed to determine the effectiveness of OSA treatment as a function of treatment efficacy and compliance. The aim of this study is to compare therapeutic outcomes in CPAP-intolerant patients with OSA treated with transoral robotic surgery (TORS) lingual tonsillectomy and upper airway stimulation (UAS) using MDA as a primary outcome measure.

Methods: A retrospective study of patients with OSA refractory to CPAP that underwent UAS or TORS from 2015-2022 was conducted. Demographics and sleep study results were reviewed. UAS compliance was defined as the proportion of nights used ≥4 hours; TORS compliance was defined as 100%.

Results: In total, 159 patients (127 UAS and 32 TORS) were included. TORS patients were significantly younger than UAS patients (43.48 ± 14.46 vs 61.47 ± 11.02; p < 0.0001). AHI decreased significantly postoperatively in both TORS and UAS patients (p < 0.001) Following 3:1 matching, there was no significant difference in AHI reduction between TORS and UAS patients (22.95 ± 21.99 vs 24.28 ± 15.86; p = 0.4). This relationship persisted when examining MDA as there was no significant difference between TORS and UAS patients (41.56 ± 58.24 vs 49.76 ± 28.61; p = 0.8).

Conclusions: MDA is a useful metric that combines both compliance and efficacy to determine the clinical effectiveness of a treatment. Our data shows that the clinical effectiveness of TORS and UAS is comparable and thus both are promising treatment options for well-selected OSA patient's refractory to CPAP.