Quality of Life Evaluation of Maxillomandibular Advancement Surgery for Treatment of Obstructive Sleep Apnea

Abstract

The purpose of this study was to investigate the quality of life (QOL) for patients who underwent maxillomandibular advancement (MMA) surgery for obstructive sleep apnea (OSA) treatment using the Functional Outcomes of Sleep Questionnaire (FOSQ). Correlation of the findings with parameters from the polysomnograph (PSG) and physical examination were also performed. No QOL studies have been carried out for MMA in OSA, and the FOSQ is the most appropriate method. The FOSQ instrument is a survey designed to evaluate QOL in OSA and proven to be effective. All patients followed a standard prospective protocol of pre- and 6 months postoperative data collection. Clinical radiographs, PSG, FOSQ, endoscopy, and computed tomography scans were analyzed. Fifteen patients with complete data were included in the study. There was minimal change in the BMI from a preoperation mean of 32.10 to 31.50 at 6 months postoperation. The operation was 86.7% (13 of 15) successful (postoperative apnea and hypopnea index [AHI] decreased by 50% and was <20), with a significant decrease of the mean preoperation apnea-hypopnea index (AHI) of 69.12 to 13.87 postoperation (P < .0001). The minimum oxygen saturation (Lsat) correspondingly increased from a mean of 76.49 to 84.96 (P = .0001). A total of 93.3% of our patients achieved a successful QOL change based on a FOSQ score of greater than or equal to 18. There was statistically significant changes in all domains; general productivity (P = .0003), social outcome (P = .0020), activity level (P = .0008), vigilance (P = .0028), intimacy and sex (P = .0039), and the total score (P = .0002) postoperatively. Changes of Lsat and AHI were highly correlated (r = -0.728, P = .002). The magnitude of the Le Fort advancement was also found to be negatively correlated to the change in AHI (r = -0.544, P =.036). There was no correlation between the FOSQ scores and all other parameters, including both the PSG parameters (AHI and Lsat). MMA remains the most effective operation for the treatment of OSA and yet no QOL studies have been carried out. The disease-specific QOL instrument (FOSQ) showed the subjective functional improvement in MMA patients. QOL instruments should be used for all surgical based treatment as they add a new dimension to the assessment of the patient and procedures.