Why are patients not compliant to continuous positive airway pressure (CPAP) treatment for sleep apnoea?

Annals of Medicine &Amp; Surgery

Kythreotou

Georgalas

et al. 2017

A best evidence topic was written according to a structured protocol. The question addressed was whether TransOral Robotic Surgery (TORS) is a safe and effective multilevel treatment for Obstructive Sleep Apnoea (OSA) in obese patients following failure of conventional treatment(s). A total of 39 papers were identified using the reported searches of which 5 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Existing treatments for OSA - primarily CPAP - though highly effective are poorly tolerated resulting in an adherence often lower than 50%. As such, surgery is regaining momentum, especially in those patients failing non-surgical treatment (CPAP or oral appliances). TORS represents the latest addition to the armamentarium of Otorhinolaryngologists - Head and Neck Surgeons for the management of OSA. The superior visualisation and ergonomics render TORS ideal for the multilevel treatment of OSA. However, not all patients are suitable candidates for TORS and its suitability is questionable in obese patients. In view of the global obesity pandemic, this is an important question that requires addressing promptly. Despite the drop in success rates with increasing BMI, the success rate of TORS in non-morbidly obese patients (BMI = 30-35kgm-2) exceeds 50%. A 50% success rate may at first seem low, but it is important to realize that this is a patient cohort suffering from a life-threatening disease and no option left other than a tracheostomy. As such, TORS represents an important treatment in non-morbidly obese OSA patients following failure of conventional treatment(s).

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Is transoral robotic surgery a safe and effective multilevel treatment for obstructive sleep apnoea in obese patients following failure of conventional treatment(s)?

Annals of Medicine &Amp; Surgery

Kythreotou

Georgalas

et al. 2017

“…56 Although continuous positive airway pressure (CPAP) has been shown to be a highly-effective treatment, adherence rates fall below 50% pointing to the need for alternative treatment options. 17,57 This is paramount, especially in cases of moderate and severe OSA where morbidity and mortality are significant. 58 As OSA is typically a multi-level disease, 17 TORS represents an ideal multi-level treatment as a result of its superior visualisation and ergonomics.…”

Section: Tors For Obstructive Sleep Apnoeamentioning

confidence: 99%

Robotics in otorhinolaryngology – head and neck surgery

Tolley

2018

annals

“…However, compliance rates with CPAP fall below 50% [1,6]. As a result, various surgical procedures have been devised over the years to address the airway collapse depending on the anatomical level of obstruction [1].…”

mentioning

confidence: 99%

Transoral Robotic Surgery for Obstructive Sleep Apnoea-Hypopnoea Syndrome

Vauterin

Arora

2018

ORL

Obstructive sleep apnoea-hypopnoea (OSAH) syndrome constitutes a major health care problem. Surgical modalities for the treatment of OSAH are regaining momentum in view of the increasing prevalence of OSAH and the low compliance rates associated with continuous positive airway pressure. There are several investigations to complement clinical examination in accurately determining the level of airway collapse to ensure correct patient selection and a targeted surgical approach. The most commonly employed include drug-induced sleep endoscopy and imaging with the tongue base and epiglottis often revealed as the major sites of airway narrowing during sleep. In the continuing search for the optimal approach to address these areas, transoral robotic surgery (TORS) has been successfully used for tongue base reduction and epiglottoplasty. With sufficient experience, this technique is safe and well tolerated. Meticulous work-up and careful patient selection are crucial. Multiple studies have demonstrated very good short-term results of TORS for OSAH, with significant reduction in both the Apnoea-Hypopnea Index (AHI) and Epworth Sleepiness Score (ESS). With the appropriate infrastructure, proctoring, and access to robotic surgical technology, it is possible for these results to be reproduced more widely. Further prospective long-term clinical evaluation will ultimately determine the exact role of TORS in the treatment of OSAH.