Scott B Boyd1, Radhika Chigurupati2, Joseph E Cillo3, Gail Eskes4, Reginald Goodday5, Tina Meisami6, Christopher F Viozzi7, Peter Waite8, James Wilson9. 1. Professor of Oral and Maxillofacial Surgery, Retired Faculty, Vanderbilt University Medical Center, Nashville, TN. Electronic address: scott.boyd@vanderbilt.edu. 2. Associate Professor and Director of Research, Department of Oral and Maxillofacial Surgery, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA. 3. Associate Professor, Program Director, and Director of Research, Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, Pittsburgh, PA. 4. Professor, Department of Psychiatry and Department of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada. 5. Professor and Past Chair, Department of Oral and Maxillofacial Sciences, Dalhousie University, Halifax, Nova Scotia, Canada. 6. Director of Dental Sleep Medicine, Department of Oral and Maxillofacial Surgery, University of Toronto, Toronto, Ontario, Canada. 7. Assistant Professor of Surgery and Chair, Division of Oral and Maxillofacial Surgery, Mayo Clinic, Rochester, MN. 8. Professor and McCallum Chair, Department of Oral and Maxillofacial Surgery, University of Alabama School of Dentistry, Birmingham, AL. 9. Professor and Vice-Chair, Department of Oral and Maxillofacial Surgery, University of Texas at Houston, Houston, TX.
Abstract
PURPOSE: To comprehensively determine the effectiveness and safety of maxillomandibular advancement (MMA) for the treatment of obstructive sleep apnea (OSA). PATIENTS AND METHODS: We designed and implemented a prospective multicenter cohort study to evaluate OSA patients who underwent MMA. The primary outcome measures and associated instruments included sleepiness (Epworth Sleepiness Scale [ESS]), quality of life (QOL) (Functional Outcomes of Sleep Questionnaire [FOSQ]), sleep-disordered breathing (apnea-hypopnea index), cardiovascular risk (office blood pressure and levels of high-sensitivity C-reactive protein), and neurocognitive performance (psychomotor vigilance testing [PVT]). The outcomes were measured preoperatively and approximately 6 months postoperatively. Other variables were grouped into the following categories: demographic and pre-MMA use of continuous positive airway pressure. Descriptive and bivariate statistics were computed. RESULTS: The sample was composed of 30 adult patients (63% men; mean age, 45.9 ± 9.8 years). The median length of follow-up was 6.7 months (range, 4.3 to 12.7 months). The ESS score decreased from a mean of 13.3 to 4.9 (P < .001). The FOSQ score increased from a mean of 14.1 to 18.3 (P < .001). The apnea-hypopnea index decreased from a mean of 39.6 to 7.9 events per hour (P < .001). Mean diastolic blood pressure decreased from 83 to 79.7 mm Hg (P = .025). PVT response times improved after MMA (P = .04). Few treatment-related adverse events occurred, which had minimal impact on the QOL. Additional improvements in sleepiness (mean ESS score change, -7.6; P < .001), QOL (mean FOSQ score change, 3.9; P < .001), and PVT (mean change, 0.5; P = .004) occurred after MMA for patients using continuous positive airway pressure before surgery. CONCLUSIONS: MMA is a highly effective and safe treatment for OSA, which predictably leads to significant improvements in sleepiness, QOL, sleep-disordered breathing, and neurocognitive performance, as well as a reduction in cardiovascular risk (blood pressure).
PURPOSE: To comprehensively determine the effectiveness and safety of maxillomandibular advancement (MMA) for the treatment of obstructive sleep apnea (OSA). PATIENTS AND METHODS: We designed and implemented a prospective multicenter cohort study to evaluate OSA patients who underwent MMA. The primary outcome measures and associated instruments included sleepiness (Epworth Sleepiness Scale [ESS]), quality of life (QOL) (Functional Outcomes of Sleep Questionnaire [FOSQ]), sleep-disordered breathing (apnea-hypopnea index), cardiovascular risk (office blood pressure and levels of high-sensitivity C-reactive protein), and neurocognitive performance (psychomotor vigilance testing [PVT]). The outcomes were measured preoperatively and approximately 6 months postoperatively. Other variables were grouped into the following categories: demographic and pre-MMA use of continuous positive airway pressure. Descriptive and bivariate statistics were computed. RESULTS: The sample was composed of 30 adult patients (63% men; mean age, 45.9 ± 9.8 years). The median length of follow-up was 6.7 months (range, 4.3 to 12.7 months). The ESS score decreased from a mean of 13.3 to 4.9 (P < .001). The FOSQ score increased from a mean of 14.1 to 18.3 (P < .001). The apnea-hypopnea index decreased from a mean of 39.6 to 7.9 events per hour (P < .001). Mean diastolic blood pressure decreased from 83 to 79.7 mm Hg (P = .025). PVT response times improved after MMA (P = .04). Few treatment-related adverse events occurred, which had minimal impact on the QOL. Additional improvements in sleepiness (mean ESS score change, -7.6; P < .001), QOL (mean FOSQ score change, 3.9; P < .001), and PVT (mean change, 0.5; P = .004) occurred after MMA for patients using continuous positive airway pressure before surgery. CONCLUSIONS:MMA is a highly effective and safe treatment for OSA, which predictably leads to significant improvements in sleepiness, QOL, sleep-disordered breathing, and neurocognitive performance, as well as a reduction in cardiovascular risk (blood pressure).
Authors: Jessica Fitzpatrick; Eric S Kerns; Esther D Kim; Stephen M Sozio; Bernard G Jaar; Michelle M Estrella; Larisa G Tereshchenko; Jose M Monroy-Trujillo; Rulan S Parekh; Ghada Bourjeily Journal: J Clin Sleep Med Date: 2021-08-01 Impact factor: 4.324