Upper Airway Length Decreases Following Maxillomandibular Advancement in Patients With Obstructive Sleep Apnea

Abstract

Statement of the ProblemThere is increasing evidence that maxillomandibular advancement (MMA) results in alleviation of symptoms in a high percentage of patients with obstructive sleep apnea (OSA). Investigators have previously reported changes in airway anatomy following MMA with or without concomitant genial tubercle advancement (GTA). We have recently reported that upper airway length, measured on lateral cephalograms, is associated with the presence and severity of obstructive sleep apnea.2 The purpose of this study was to evaluate changes in upper airway length (UAL) associated with MMA +/− GTA.Materials and MethodsThis was a retrospective cohort study. The sample was composed of subjects who underwent MMA for OSA. The primary outcome measure was change in UAL, measured on lateral cephalograms. Predictor variables included patient demographic (age; sex; height; weight; and body mass index, BMI) and cephalometric (upper airway length, UAL; posterior airway space, PAS; hyoid-mandibular perpendicular distance, HMP) characteristics. Secondary outcome measures were changes in sleep disturbance (symptoms; respiratory disturbance index, RDI; need for continuous positive airway pressure, CPAP). Descriptive, bivariate, and regression statistics were computed. For all analyses, a P < 0.05 was considered significant.ResultsThe sample included 23 adult subjects with a mean age of 39.3 + 12.1 years; 6 subjects were female. Pre-operatively, all subjects were symptomatic, required positive-pressure therapy, and were seeking an alternative to positive-pressure therapy. Seventeen subjects (73.9%) used CPAP preoperatively; 6 subjects were unable to tolerate the positive-pressure treatment. Subjects had average maxillary and mandibular advancements of 9.8 + 2.0 and 10.8 + 2.2 mm, respectively. The mean pre- and postoperative UALs were 75.8 + 7.0 mm and 67.0 + 5.7, respectively (P < .001). The mean pre- and postoperative PAS were 7.5 + 2.5 mm and 13.0 + 3.0 mm, respectively (P < .01). The mean pre- and post-operative HMP were 25.1 + 6.8 and 22.1 + 6.0, respectively (P = .01). The mean pre- and post-operative RDI were 53.2 + 22.4 and 19.0 + 12.0 events/hr, respectively (P = .003). All patients had improvement in OSA symptoms. Three patients who were on CPAP pre-operatively continued to require it postoperatively. There were no significant associations between the magnitude of maxillary or mandibular advancement and changes in cephalometric or polysomnographic parameters (P > .17).ConclusionThe results of this study suggest that UAL decreases as a result of MMA and confirm other studies that MMA is associated with objective and subjective improvement in OSA patients. Statement of the ProblemThere is increasing evidence that maxillomandibular advancement (MMA) results in alleviation of symptoms in a high percentage of patients with obstructive sleep apnea (OSA). Investigators have previously reported changes in airway anatomy following MMA with or without concomitant genial tubercle advancement (GTA). We have recently reported that upper airway length, measured on lateral cephalograms, is associated with the presence and severity of obstructive sleep apnea.2 The purpose of this study was to evaluate changes in upper airway length (UAL) associated with MMA +/− GTA. There is increasing evidence that maxillomandibular advancement (MMA) results in alleviation of symptoms in a high percentage of patients with obstructive sleep apnea (OSA). Investigators have previously reported changes in airway anatomy following MMA with or without concomitant genial tubercle advancement (GTA). We have recently reported that upper airway length, measured on lateral cephalograms, is associated with the presence and severity of obstructive sleep apnea.2 The purpose of this study was to evaluate changes in upper airway length (UAL) associated with MMA +/− GTA. Materials and MethodsThis was a retrospective cohort study. The sample was composed of subjects who underwent MMA for OSA. The primary outcome measure was change in UAL, measured on lateral cephalograms. Predictor variables included patient demographic (age; sex; height; weight; and body mass index, BMI) and cephalometric (upper airway length, UAL; posterior airway space, PAS; hyoid-mandibular perpendicular distance, HMP) characteristics. Secondary outcome measures were changes in sleep disturbance (symptoms; respiratory disturbance index, RDI; need for continuous positive airway pressure, CPAP). Descriptive, bivariate, and regression statistics were computed. For all analyses, a P < 0.05 was considered significant. This was a retrospective cohort study. The sample was composed of subjects who underwent MMA for OSA. The primary outcome measure was change in UAL, measured on lateral cephalograms. Predictor variables included patient demographic (age; sex; height; weight; and body mass index, BMI) and cephalometric (upper airway length, UAL; posterior airway space, PAS; hyoid-mandibular perpendicular distance, HMP) characteristics. Secondary outcome measures were changes in sleep disturbance (symptoms; respiratory disturbance index, RDI; need for continuous positive airway pressure, CPAP). Descriptive, bivariate, and regression statistics were computed. For all analyses, a P < 0.05 was considered significant. ResultsThe sample included 23 adult subjects with a mean age of 39.3 + 12.1 years; 6 subjects were female. Pre-operatively, all subjects were symptomatic, required positive-pressure therapy, and were seeking an alternative to positive-pressure therapy. Seventeen subjects (73.9%) used CPAP preoperatively; 6 subjects were unable to tolerate the positive-pressure treatment. Subjects had average maxillary and mandibular advancements of 9.8 + 2.0 and 10.8 + 2.2 mm, respectively. The mean pre- and postoperative UALs were 75.8 + 7.0 mm and 67.0 + 5.7, respectively (P < .001). The mean pre- and postoperative PAS were 7.5 + 2.5 mm and 13.0 + 3.0 mm, respectively (P < .01). The mean pre- and post-operative HMP were 25.1 + 6.8 and 22.1 + 6.0, respectively (P = .01). The mean pre- and post-operative RDI were 53.2 + 22.4 and 19.0 + 12.0 events/hr, respectively (P = .003). All patients had improvement in OSA symptoms. Three patients who were on CPAP pre-operatively continued to require it postoperatively. There were no significant associations between the magnitude of maxillary or mandibular advancement and changes in cephalometric or polysomnographic parameters (P > .17). The sample included 23 adult subjects with a mean age of 39.3 + 12.1 years; 6 subjects were female. Pre-operatively, all subjects were symptomatic, required positive-pressure therapy, and were seeking an alternative to positive-pressure therapy. Seventeen subjects (73.9%) used CPAP preoperatively; 6 subjects were unable to tolerate the positive-pressure treatment. Subjects had average maxillary and mandibular advancements of 9.8 + 2.0 and 10.8 + 2.2 mm, respectively. The mean pre- and postoperative UALs were 75.8 + 7.0 mm and 67.0 + 5.7, respectively (P < .001). The mean pre- and postoperative PAS were 7.5 + 2.5 mm and 13.0 + 3.0 mm, respectively (P < .01). The mean pre- and post-operative HMP were 25.1 + 6.8 and 22.1 + 6.0, respectively (P = .01). The mean pre- and post-operative RDI were 53.2 + 22.4 and 19.0 + 12.0 events/hr, respectively (P = .003). All patients had improvement in OSA symptoms. Three patients who were on CPAP pre-operatively continued to require it postoperatively. There were no significant associations between the magnitude of maxillary or mandibular advancement and changes in cephalometric or polysomnographic parameters (P > .17). ConclusionThe results of this study suggest that UAL decreases as a result of MMA and confirm other studies that MMA is associated with objective and subjective improvement in OSA patients. The results of this study suggest that UAL decreases as a result of MMA and confirm other studies that MMA is associated with objective and subjective improvement in OSA patients.