Authors' response

Abstract

We appreciate the interest and the insightful comments on our article. In our sample, we had a total of 25 patients who were diagnosed with moderate to severe obstructive sleep apnea syndrome (OSAS). The inclusion criteria consisted of patients who had pretreatment sleep study reports to confirm the diagnosis of sleep apnea but not posttreatment sleep data. We strongly agree that including posttreatment sleep reports would be more meaningful in terms of clinical application. However, most of the patients in the study were not willing to pursue the posttreatment sleep study because the OSAS symptoms disappeared, and their quality of sleep was significantly improved after the surgical procedure. This was why we were not able to include the posttreatment sleep data in our article. However, we can share one of the typical cases for which we have the pretreatment and posttreatment sleep report: a 55-year-old male with a chief concern of excessive daytime sleepiness and fatigue. The initial polysomnography (PSG) report showed a moderate OSAS with an apnea-hypopnea index (AHI) of 21.2 events/h, an Epworth Sleepiness Scale score of 12/24, and a body mass index of 25.6 kg/m2. Two months after the maxillomandibular advancement procedure, another PSG study was performed. Based on the surgical criteria for successful treatment,1Elshaug A.G. Moss J.R. Southcott A.M. Hiller J.E. Redefining success in airway surgery for obstructive sleep apnea: a meta analysis and synthesis of the evidence.Sleep. 2007; 30: 461-467Crossref PubMed Scopus (127) Google Scholar which includes a >50% reduction of baseline AHI and a posttreatment AHI <20, there was almost a complete resolution of the patient's OSAS with a postoperative AHI of 0.7 events/h and Epworth Sleepiness Scale score of 3. The lowest oxyhemoglobin saturation during sleep was elevated to 97%, and the body mass index decreased to 25.2 kg/m2. In our study, a partial loss in oropharyngeal airway space was found during the short-term follow-up visit after the edema regressed. However, all patients reported improvement in the quality of sleep. This finding is consistent with the cephalometric and PSG study by Conradt et al,2Conradt R. Hochban W. Brandenburg U. Heitmann J. Peter J.H. Long-term follow-up after surgical treatment of obstructive sleep apnoea by maxillomandibular advancement.Eur Respir J. 1997; 10: 123-128Crossref PubMed Scopus (106) Google Scholar reporting success in maxillomandibular advancement treatment that was stable over 2 years. Thank you again for the opportunity to discuss our study. We look forward to a follow-up study with a longer follow-up period and posttreatment sleep study data. Maxillomandibular advancement for treatment of obstructive sleep apneaAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 159Issue 4PreviewI congratulate AlSaty et al for their article in October 2020 (AlSaty G, Xiang J, Burns M, Eliliwi M, Palomo JM, Martin C, et al. Follow-up observation of patients with obstructive sleep apnea treated by maxillomandibular advancement. Am J Orthod Dentofacial Orthop 2020;158:527-34). The research provides valuable information about the airway changes in patients with obstructive sleep apnea syndrome (OSAS) treated with maxillomandibular advancement (MMA). Full-Text PDF