Patty E Vonk1, Perry J Rotteveel1, Madeline J L Ravesloot1,2, Jean-Pierre T F Ho3, Jan de Lange3, Nico de Vries1,4,5. 1. Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Amsterdam, the Netherlands. 2. Department of Otorhinolaryngology, Medical Centre Jan van Goyen, Amsterdam, the Netherlands. 3. Department of Oral and Maxillofacial Surgery, Amsterdam UMC/ACTA, Amsterdam, the Netherlands. 4. Department of Oral Kinesiology, ACTA, MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands. 5. Faculty of Medicine and Health Sciences, Department of Otorhinolaryngology, Head and Neck Surgery Antwerp University Hospital, Antwerp, Belgium.
Abstract
STUDY OBJECTIVES: (1) To evaluate surgical success in patients with obstructive sleep apnea undergoing maxillomandibular advancement (MMA) stratifying for the reduction of both the total apnea-hypopnea index (AHI) and the AHI in the supine and nonsupine position; (2) to evaluate the influence of position dependency on surgical outcome; and (3) to analyze the prevalence of residual position-dependent obstructive sleep apnea (OSA) in nonresponders after MMA. METHODS: A single-center retrospective study including a consecutive series of patients with OSA undergoing MMA between August 2011 and February 2019. RESULTS: In total, 57 patients were included. The overall surgical success was 52.6%. No significant difference in surgical success between nonpositional patients (NPP) and positional patients (PP) with OSA was found. Surgical success of the supine AHI was not significantly different between NPP and PP, but surgical success of the nonsupine AHI was significantly greater in NPP than in PP. Of the 17 preoperative NPP, 13 of them moved to being PP with less severe OSA postoperatively. In total, 21 out of 27 nonresponders (77.8%) were PP postoperatively. CONCLUSIONS: No significant difference in surgical success between NPP and PP undergoing MMA was found. However, the improvement of total and nonsupine AHI in NPP was significantly greater compared to PP. In nonresponders, a postoperative shift from severe OSA in NPP to less severe OSA in PP was found, caused by a greater reduction of the nonsupine AHI than the supine AHI postoperatively. In patients with residual OSA in the supine position after MMA, additional treatment with positional therapy can be indicated.
STUDY OBJECTIVES: (1) To evaluate surgical success in patients with obstructive sleep apnea undergoing maxillomandibular advancement (MMA) stratifying for the reduction of both the total apnea-hypopnea index (AHI) and the AHI in the supine and nonsupine position; (2) to evaluate the influence of position dependency on surgical outcome; and (3) to analyze the prevalence of residual position-dependent obstructive sleep apnea (OSA) in nonresponders after MMA. METHODS: A single-center retrospective study including a consecutive series of patients with OSA undergoing MMA between August 2011 and February 2019. RESULTS: In total, 57 patients were included. The overall surgical success was 52.6%. No significant difference in surgical success between nonpositional patients (NPP) and positional patients (PP) with OSA was found. Surgical success of the supine AHI was not significantly different between NPP and PP, but surgical success of the nonsupine AHI was significantly greater in NPP than in PP. Of the 17 preoperative NPP, 13 of them moved to being PP with less severe OSA postoperatively. In total, 21 out of 27 nonresponders (77.8%) were PP postoperatively. CONCLUSIONS: No significant difference in surgical success between NPP and PP undergoing MMA was found. However, the improvement of total and nonsupine AHI in NPP was significantly greater compared to PP. In nonresponders, a postoperative shift from severe OSA in NPP to less severe OSA in PP was found, caused by a greater reduction of the nonsupine AHI than the supine AHI postoperatively. In patients with residual OSA in the supine position after MMA, additional treatment with positional therapy can be indicated.
Authors: Christel A L de Raaff; Marguerite A W Gorter-Stam; Nico de Vries; Ashish C Sinha; H Jaap Bonjer; Frances Chung; Usha K Coblijn; Albert Dahan; Rick S van den Helder; Antonius A J Hilgevoord; David R Hillman; Michael P Margarson; Samer G Mattar; Jan P Mulier; Madeline J L Ravesloot; Beata M M Reiber; Anne-Sophie van Rijswijk; Preet Mohinder Singh; Roos Steenhuis; Mark Tenhagen; Olivier M Vanderveken; Johan Verbraecken; David P White; Nicole van der Wielen; Bart A van Wagensveld Journal: Surg Obes Relat Dis Date: 2017-03-30 Impact factor: 4.734
Authors: Wietske Richard; Dennis Kox; Cindy den Herder; Martin Laman; Harm van Tinteren; Nico de Vries Journal: Eur Arch Otorhinolaryngol Date: 2006-06-27 Impact factor: 2.503
Authors: C Kastoer; L B L Benoist; M Dieltjens; B Torensma; L H de Vries; P E Vonk; M J L Ravesloot; N de Vries Journal: Sleep Breath Date: 2018-08-01 Impact factor: 2.816