The aim is to investigate whether the tissue-preserving tonsil surgery technique is as effective as complete tonsil removal in the treatment of obstructive sleep apnea. The primary outcome measure is the change in the apnea-hypopnea index (AHI) before surgery and at 4-6, 24, and 60 months after surgery.
Adult reviews suggest tonsillotomy (TT) reduces morbidity compared to tonsillectomy (TE). In pediatric populations, the effectiveness of partial tonsil surgery for sleep apnea (OSA) is well-documented. It remains unclear if TT is non-inferior to TE in adults in the treatment of OSA. This study compares TE with TT in adults using change in apnea-hypopnea index as the primary endpoint. The hypothesis is that TT is non-inferior compared to TE in treating patients with moderate or severe OSA and grade 2 to 4 tonsil size. Participants are blinded to the allocated intervention with an allocation ratio 1:1. Participants will be recruited from patients referred to an outpatient hospital clinic. The trial will be carried out in four tertiary hospitals in Finland.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
132
TE will be performed by dissection in the peritonsillar plane. Parts of the upper and lateral palatal mucosal arches will be incised, and an extracapsular dissection for complete tonsil excision will be performed.
TT will be performed by removing approximately 60 - 90% of the tonsillar tissue, leaving a rim of tonsillar tissue on the tonsillar fossae. The tonsil capsule will not be breached.
Helsinki University Hospital
Helsinki, Finland
Oulu University Hospital
Oulu, Finland
Tampere University Hospital
Tampere, Finland
Turku University Hospital
Turku, Finland
Changes in AHI at baseline and after surgery
The primary outcome is changes in AHI measured with home sleep study
Time frame: baseline, 4-6, 24 and 60 months after surgery.
Daytime sleepiness
Measured with Epworth Sleepiness Scale (ESS) questionnaire (patient-reported). Points 0-18, higher is worse.
Time frame: Baseline and 6, 12, 24 and 60 months after surgery
Changes in insomnia symptoms
Measured with Insomnia Severity Index (ISI) questionnaire, points range 0-28, higher is worse.
Time frame: Baseline and 6, 12, 24 and 60 months after surgery
Surgical success rate
Defined according to Sher's criteria: a reduction in AHI of \>50% and a total AHI of \<20 after surgery
Time frame: Baseline and 6, 12, 24 and 60 months after surgery
Surgical cure rate
Defined as a total AHI of \<5 after surgery
Time frame: Baseline and 6, 12, 24 and 60 months after surgery
Changes in nocturnal desaturation
Changes in nocturnal desaturation measured with oxygen saturation (SaO2) mean, min, and SpO2 \<90% (T90) and ODI3, measured with home sleep study
Time frame: Before surgery and 4-6, 24 and 60 months after surgery
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