Silent Changes in Sleep Quality Following Mandibular Setback Surgery in Patients with Skeletal Class III Malocclusion: A Prospective Study

Sung Woon On,Seung Il Song,Hyun Jun Kim,Dong Hyeon Cho,Yeo Rae Moon

doi:10.1038/s41598-019-46166-z

Sung Woon On, Seung Il Song + Show 3 more

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https://doi.org/10.1038/s41598-019-46166-z

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Abstract

Mandibular setback surgery (MSS) for skeletal class III patients can result in a relative reduction of pharyngeal airway space (PAS). Consequently, there is a possibility of the decline of sleep quality after surgery. We investigated changes in sleep quality measured by overnight polysomnography (PSG) and the three-dimensional (3D) volumes of PAS following MSS with or without Le Fort I osteotomy (LF I) in class III patients (N = 53). Overnight PSG and cone beam computed tomography were conducted at preoperative stage (T0) and postoperative 3 months (T1). Measurements of PAS volumes were performed, and the subjective symptoms of sleep were evaluated by self-questionnaires. There were significant increases in respiratory disturbance index (RDI) and total respiratory effort-related arousal (RERA) index during T0-T1. The 3D volumes of PAS showed significant decreases in the oropharyngeal airway, hypopharyngeal airway, and total airway spaces. No significant changes were observed in subjective symptoms of sleep. MSS with or without LF I for class III patients could worsen sleep quality by increasing sleep parameters such as the RDI and RERA in PSG, and reduce volumes of PAS at postoperative 3 months. Although subjective symptoms may not show significant changes, objective sleep quality in PSG might decrease after MSS.

Highlights

Ajou University Medical Center, Suwon, Republic of Korea
Multiple stepwise logistic regression with additional insertion of the amounts of mandibular setback as an independent variable selected preoperative relative snoring time, and lowest oxygen saturation. In this prospective study using overnight full PSG and 3D analysis with cone beam computed tomography (CBCT), Mandibular setback surgery (MSS) with or without maxillary surgical movement for skeletal class III patients resulted in significant changes in the sleep parameters of PSG, and volumes of pharyngeal airway space (PAS)
Several correlations between the sleep parameters in PSG and the amount of mandibular setback might indicate that the larger mandibular posterior movement is, the worse sleep quality becomes

Summary

Introduction

Ajou University Medical Center, Suwon, Republic of Korea. Sung Woon On and Hyun Jun Kim contributed . Www.nature.com/scientificreports parameters in PSG and volumetric changes in the pharyngeal airway dimension using computed tomography. It is logical to investigate the correlations between the sleep parameters in PSG and three-dimensional (3D) changes in upper airway space for identifying the unbeknown factors involved in OSA. The aims of the present study were: (1) to investigate changes in the sleep parameters of PSG and the 3D volume of PAS following MSS with or without maxillary movement in skeletal class III patients; (2) to identify possible correlations among the sleep parameters in PSG, volumetric changes in PAS, subjective symptoms of patients, and other demographic data such as the amounts of surgical movements of the mandible; and (3) to elucidate the factors affecting the occurrence of OSA after MSS

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