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

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.