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

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.

Head-Of-Bed Elevation (HOBE) for Improving Positional Obstructive Sleep Apnea (POSA): An Experimental Study

“…The pathophysiology of OSA is complex and is related to the interplay of both anatomical and non-anatomical factors, including neuromuscular responsiveness, ventilatory instability, and arousal threshold [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. All these aspects should be considered in the genesis of POSA patients and could be related to the positive effect of the HOBE position.…”

OSA: Treatments beyond CPAP

“…OSA is characterized by repeated complete (apnea) or partial (hypopnea) reduction of airflow in the upper airway during sleep [ 1 , 3 , 4 ].…”

“…Furthermore, daytime sleepiness typically complained by OSA patients has a significant impact on their quality of life and increases the risk of motor vehicle accidents [ 1 , 2 , 4 ].…”

“…Diagnosis is traditionally based on medical history, Epworth Sleepiness Scale (ESS) and sleep tests such as polysomnography [ 2 , 3 , 4 ].…”

Aktuelle Entwicklungen in der Schlafforschung und Schlafmedizin – eine Einschätzung der AG „Geriatrie“

“…Hier gibt es noch großes Forschungspotenzial und wahrscheinlich sind die Bedingungen wechselseitig. Allerdings zeigen zahlreiche Studien der letzten fünf Jahre, dass zumindest im Bereich Schlafapnoe, zentral und obstruktiv, bei älteren Menschen eine PAP(Positive Airway Pressure)-Therapie zu einer Verbesserung der Lebensqualität und mittelfristig auch einer Verbesserung der Kognition führen kann, was darauf schließen lässt, dass hier die Schlafstörung, die Schlafapnoe, die Henne ist, die das Ei dementielle Entwicklung und weitere klinische Symptome legt [3][4][5].…”