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Ear, Nose & Throat Journal 99(8)

Table 4. Correlation of body mass index (BMI) Change with pulmonary function test (PFT) Values at Sixth Month.
Preop/postop Sixth Month PFT Values
FVC

FEV1

FEV1/FVC

Preop-/postop-sixth month BMI
r
À0.222
À0.230
À0.140
P
.222
.206
.446

PEF

FEF2575

À0.248
.171

0.204
.262

(P <.05; Table 3). Also, there was a statistically significant
positive correlation between the preoperative/thirdpostoperative month BMI change and the preoperative/thirdpostoperative month FEF 25-75 change (P < .05; Table 3).
However, there was no statistically significant correlation
between preoperative/sixth-postoperative month BMI change
and preoperative/sixth-postoperative-month FVC, FEV1,
FEV1/FVC, PEF, and FEF25-75 change (P > .05; Table 4).
Between third and sixth month, although the BMI values of
patients have increased slightly, the improvement in PFT values continues at postoperative sixth month (Table 4).

Discussion
Obstructive sleep apnea syndrome is a syndrome characterized
by recurrent partial or complete upper respiratory tract obstruction resulting in hypoxia during sleep. Socioeconomic outcomes are extremely important in terms of community
health. Obstructive sleep apnea syndrome is an important risk
factor for hypertension, myocardial infarction, and stroke as
well as impairment of the quality of life of the patient.9
Pathophysiology in many areas such as velopharynx, oropharynx, tongue base, and epiglottis may cause upper respiratory tract obstruction and cause OSAS. The obstruction at the
level of the tongue base is one of the most common causes of
sleep apnea. Obstructive sleep apnea syndrome is a multisystemic disease affecting all body systems, especially the cardiovascular system, and has a negative effect on the quality of
life. While positive airway pressure is an effective treatment
option in OSAS treatment, a significant proportion of patients
cannot tolerate this treatment method and alternative treatment
methods are frequently sought. Transoral robotic tongue base
surgery is a new technique in the surgical treatment of patients
with OSAS.9
Obstructive sleep apnea syndrome is a relatively neglected
disease that is difficult to treat and is a main cause of major
health problems. There are 2 options in treatment: ventilation
and surgery. Before surgery, each patient must be wellassessed and the pathology leading to obstruction should be
determined correctly.11
The anatomy of the base of the tongue, the complex relationship with the surrounding tissues, and the critical physiological function complicate the surgical intervention and
increase the rate of complications.11
Techniques developed for surgical treatment of tongue base
hypertrophy leading to OSAS include genioglossus

advancement, tongue base radiofrequency ablation, and hyoid
suspension. The traditional method for transoral approaches to
the tongue base is to use an endoscope or a surgical microscope. However, in these techniques, the view of the surgical
field is rather limited and the sense of depth is lost. Cervical
approaches have also been described by performing pharyngotomy in the approach to the tongue base, but morbidity can be
seriously high in these approaches.12
The use of TORS in the surgical treatment of tongue baserelated OSAS was first described by Vicini. 9 The most
important advantage of a TORS is the ability to provide
three-dimensional views and tissue resection on all planes. The
lack of external incision is another advantage over open
approaches. The fact that the operation time is shorter and the
lack of need for opening the tracheotomy make TORS superior
to other techniques.12 In the TORS method, it has been reported
that the pain is similar to nonrobotic methods in the postoperative period. The disadvantages of TORS include lack of tactile
sensation, difficulty in controlling bleeding in some cases, and
heavy economic burden.11
None of the 32 patients who underwent robotic surgery
during our study had complications such as bleeding, respiratory failure, or airway injury. Respiratory problems are commonly seen in patients with OSAS before or after surgery.
There is evidence of many OSAS patients suffering from
chronic obstructive pulmonary disease (COPD) in the literature. This association is called overlap syndrome (OVS). It was
first described by Flenley in 1985. Likewise, asthma, cystic
fibrosis, and respiratory system diseases such as interstitial
pulmonary fibrosis are other conditions associated with OVS.
The issue of whether COPD is more frequent in patients with
OSAS or vice versa is still controversial.13 Chaouat et al. investigated the prevalence of OVS due to COPD in patients with
OSAS and found a high value of 11%. Patients with OVS have
been found to be at very high risk for respiratory failure and
pulmonary hypertension even with a low degree of obstruction.
The rates of hypoxemia, hypercapnia, and pulmonary hypertension in patients with OSAS were 27%, 10%, and 17%, respectively, whereas in the OVS group, the corresponding values
were 57%, 27%, and 42%.13
Prevalence is thought to be higher in patients with more
severe COPD. It has been suggested that the occurrence of
OVS at such a high rate is probably due to the similarity of
known risk factors for both diseases. Because nocturnal oxygen
desaturation is more prominent in association with COPD þ
OSAS, it should not be forgotten that patients with COPD with
OVS pointed to poor prognosis, and clinically rapid progression should be evaluated for a possible association of OSAS.13
The purpose of performing PFTs on all our OSAS study
participants was in hopes to reveal any such relationship. It is
widely known that sleep apnea could trigger an asthmatic
attack in patients with OSAS suffering from associated asthma.
Hypoxia, which we often observe in patients with OSAS, can
lead to reflex bronchospasm through the stimulation of carotid
bodies, and asthma attacks are associated with marked reduction in upper airway caliber and are common in OSAS.

ENT - September 2020

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