Maxillomandibular Advancement Improves Multiple Health-Related and Functional Outcomes in Patients With Obstructive Sleep Apnea: A Multicenter Study

Abstract

To comprehensively determine the effectiveness and safety of maxillomandibular advancement (MMA) for the treatment of obstructive sleep apnea (OSA). 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 6months 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. The sample was composed of 30 adult patients (63% men; mean age, 45.9±9.8years). The median length of follow-up was 6.7months (range, 4.3 to 12.7months). 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 79.7mm 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. 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).