Mandibular advancement for adult obstructive sleep apnea: A systematic review and meta-analysis

Noller, Michael; Guilleminault, Christian; Gouveia, Christopher J.; Mack, Douglas P.; Vivian, Charles; Abdullatif, José; Mangili, Stefano; Liu, Stanley Yung‐Chuan; Zaghi, Soroush; Camacho, Macario

doi:10.1016/j.jcms.2017.10.006

Cited by 34 publications

(23 citation statements)

References 18 publications

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“…Serious consideration should be given to MMA surgery as a first‐line therapy in such patients according to the present findings. Previous studies also indicated that MMA surgery reduces upper airway collapsibility at multiple levels, thereby relieving upper airway obstruction and restoring sleep architecture . Although MMA surgery could be considered a more intrusive procedure, when it becomes the most favorable treatment option and the patient can tolerate such a procedure, it will avoid consecutive minor surgical procedures with uncertain outcome measures.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies also indicated that MMA surgery reduces upper airway collapsibility at multiple levels, thereby relieving upper airway obstruction and restoring sleep architecture. 9,34 Although MMA surgery could be considered a more intrusive procedure, when it becomes the most favorable treatment option and the patient can tolerate such a procedure, 10 it will avoid consecutive minor surgical procedures with uncertain outcome measures. MMA could decrease total treatment time and offer faster effective management of OSA, a more favorable cost-to-benefit ratio, and reduced anesthetic and surgical risks.…”

Section: Discussionmentioning

confidence: 99%

“…8 MMA involves advancement of both jaws following a Le Fort 1 maxillary osteotomy in conjunction with a bilateral sagittal split osteotomy of the mandible. 9,10 The high success rate of MMA is linked to a decrease in UA collapsibility. This is due to advancement of the skeletal framework, 11 thereby counteracting UA obstruction simultaneously at multiple levels.…”

Section: Introductionmentioning

confidence: 99%

“…8,12 The outcomes of MMA surgery have been equated to those of CPAP. 9,10 When non-CPAP treatment is considered, upfront patient selection through UA obstruction analysis is paramount to success, as UA collapse can occur at one or multiple levels, and these levels must be targeted. 8,13,14 Assessment of the upper airway in a dynamic way, thereby characterizing the level(s), pattern(s), and degree(s) of collapsibility, has become part of this patient selection.…”

Section: Introductionmentioning

confidence: 99%

“…Maxillomandibular advancement (MMA) is the most successful surgical intervention for OSA aside from tracheostomy . MMA involves advancement of both jaws following a Le Fort 1 maxillary osteotomy in conjunction with a bilateral sagittal split osteotomy of the mandible . The high success rate of MMA is linked to a decrease in UA collapsibility.…”

Section: Introductionmentioning

confidence: 99%

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Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

et al. 2019

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Objectives/Hypothesis To evaluate upper airway (UA) collapse patterns during drug‐induced sleep endoscopy (DISE) and maxillomandibular advancement (MMA) surgery outcome, paying particular attention to the DISE phenotype complete concentric collapse at the level of the palate (CCCp). Study Design Prospective case series. Methods Nineteen patients diagnosed with obstructive sleep apnea (OSA) prospectively underwent mandibular advancement device (MAD) treatment followed by MMA surgery. UA collapse patterns were evaluated before and after MMA surgery. Baseline apnea‐hypopnea index (AHI) was compared with AHI during MAD treatment and after MMA surgery. UA collapse patterns and the presence of baseline CCCp were assessed. AHI differences between patients with and without CCCp after MMA surgery were compared. Results In 14 patients, a full dataset was obtained: 8/6 (male/female), mean age = 51 ± 7 years, body mass index (BMI) = 25.6 ± 3.7 kg/m2, and baseline AHI = 40.2 ± 25.6 per hour of sleep. MMA surgery reduced AHI to 9.9 ± 7.2 per hour of sleep (P = .0001). Eight patients benefited from additional AHI reduction compared to MAD treatment (P = .0113). Six out of 14 (43%) patients showed baseline CCCp. Baseline patient characteristics (age, BMI, and AHI) did not significantly differ between patients with and without CCCp. AHI was equally reduced after MMA, whether (P = .0145) or not (P = .0075) CCCp was present at baseline. All patients showed resolution of CCCp (P = .0159) during postoperative DISE. Conclusions CCCp seems not to be a negative predictor for MMA surgery outcome measured by AHI reduction. Furthermore, MMA is likely to eliminate CCCp. Therefore, MMA might be a solution for OSA patients showing CCCp and broadens the perspective for personalized medicine and combination therapy. However, a large sample is required for definitive results. Level of Evidence 4 Laryngoscope, 130:E268–E274, 2020

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

et al. 2019

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International Consensus Statement on Obstructive Sleep Apnea

Chang

Goldberg

Alt

et al. 2023

Int Forum Allergy Rhinol

116

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Background: Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). Methods: Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidencebased review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. Results: The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. Conclusion:This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

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Palatal Coupling Maneuvers Do Not Predict Hypoglossal Nerve Stimulator Treatment Efficacy

et al. 2022

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Objective(s): Maneuvers during drug-induced sleep endoscopy (DISE), for patients with obstructive sleep apnea (OSA), have been used as predictors for success with oral appliances. Hypoglossal nerve stimulation (HGNS) promotes opening at the velum through palatoglossus coupling. In this study, we evaluate maneuvers during DISE as predictors for HGNS treatment efficacy.Methods: We evaluated patients undergoing HGNS between November, 2014 and February, 2021. We assessed maneuvers including jaw thrust and chin lift during preoperative DISE. The impact of tongue base and palatal opening during these maneuvers were rated from 1 to 4 (1: no improvement, 2: mild improvement, 3: moderate improvement, 4: significant improvement). Patients were grouped by a score of 1-2 (weak response) or 3-4 (strong response). Apnea hypopnea index (AHI) change was calculated from the difference between preoperative and postoperative sleep study.Results: One hundred and seventy one patients were included. With jaw thrust, there was no significant difference in AHI change between patients with weak or strong response at the palate (n = 68 vs. 94, 9.5 vs. 13.6, p = 0.21) or tongue base (n = 24 vs. 138, 16.6 vs. 11.3, p = 0.24). On chin lift, there was no significant difference at the palate (n = 82 vs. 18, 13.9 vs. 11.4, p = 0.63) or tongue base (n = 92 vs. 72, 10.8 vs. 14.6, p = 0.24). On multiple linear regression analysis, lower body mass index, higher preoperative AHI, and higher preoperative oxygen nadir were associated with a larger AHI change.Conclusion: Palatal coupling maneuvers during DISE are not predictive of AHI change with HGNS. Findings using these maneuvers should not preclude HGNS candidacy.

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Mandibular advancement for adult obstructive sleep apnea: A systematic review and meta-analysis

Cited by 34 publications

References 18 publications

Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

International Consensus Statement on Obstructive Sleep Apnea

Palatal Coupling Maneuvers Do Not Predict Hypoglossal Nerve Stimulator Treatment Efficacy

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