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Am I a Candidate for Surgery

Ideal candidate for TORS

  1. BMI <31
  2. Moderate to severe OSA (AHI >20)
  3. Recent sleep study within 3 years
  4. Daytime fatigue (Epworth Sleepiness Scale >10)

Preoperative evaluation of patients for TORS includes a thorough office examination followed by diagnostic drug induced sedated endoscopy (DISE). Patients referred for TORS are advised that a polysomnogram (sleep study) must be obtained within one year of their evaluation. Patients with moderate to severe OSA (AHI >20) are the best candidates for TORS; patients with an AHI <20 are often candidates for other treatments including oral appliance or tonsillectomy and UPPP with or without thyro-hyoidopexy. In some instances patients with mild OSA may benefit from TORS depending on the results found at sedated endoscopy (DISE).

Many patients who are seen for TORS have had previous failed surgical attempts to cure their sleep apnea. TORS provides a new option for these patients as it addresses the problem of obstruction by removing tissue from the back of the tongue (lingual tonsil). Traditional surgery does not address the tongue base, which is often the primary site of obstruction. Combined with DISE, the surgeon is able to target and remove the obstructing tissue safely and effectively.

The application of TORS to the treatment of OSA is new, and the affects on the growing tongue base and voice box have not been studied. TORS should not be performed on patients under 18 years of age.

A large international study of 243 patients has shown TORS to have an efficacy of 67% in patients with a BMI under 30 (See BMI calculator). These patients were no longer required to use CPAP. As BMI increases the results of TORS are not as predictable.

The obesity epidemic in North America has increased the prevalence of OSA; the incidence of OSA in severely obese patients is as follows: BMI 35-39 (71%), 40-49 (74%), 49-59 (79), >60 (95%). Surgeons offering TORS as an option for their patients with OSA must proceed judiciously and not raise unrealistic expectations for success in obese patients. Despite ideal anatomic criteria for TORS, cure of OSA in obese patients remains elusive. It is advisable to encourage obese patients to enter a medical weight loss program while using PAP. Many patients will find that their OSA resolves with weight loss. Medical weight loss programs are offered in most communities (HMR weight loss program). Repeat polysomnography should be performed after targeted weight loss has been achieved. Many comprehensive sleep labs will offer clinics to improve compliance with PAP.

Bariatric surgery may also be an option for patients with severe obesity (BMI >40). Bariatric surgery is a very effective tool for the treatment of OSA with a success rate of 70%.

Preoperative criteria for Inspire

  1. BMI <33
  2. Moderate to severe OSA (AHI 20-65)
  3. Sleep study within 3 years
  4. Sleep endoscopy with no concentric collapse