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

Boyd, Scott B.; Chigurupati, Radhika; Cillo, Joseph E.; Eskes, Gail A.; Goodday, Reginald; Meisami, Tina; Viozzi, Christopher F.; Waite, Peter D.; Wilson, James W.

doi:10.1016/j.joms.2018.06.173

Cited by 36 publications

(68 citation statements)

References 54 publications

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“…51 Recently, a prospective multicenter study which evaluated the success of MMA for OSA reported significant improvements in mean ESS (13.3 to 4.9) and AHI (39.6 to 7.9) values. 52 These results are consistent with the 2016 meta-analysis by Zaghi et al, which documented 98.8% improvement in AHI and RDI values after MMA, based on 45 studies with a total of 518 unique cases. 53 Every surgery carries risks and potential complications, likewise MMA is an invasive surgery that could cause numbness, pain and swelling around the maxillofacial region.…”

Section: Maxillomandibular Advancementsupporting

confidence: 89%

Overview of Surgical Therapies for Obstructive Sleep Apnea: a Concise Review Literature

Suphangul

2020

Smj

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The surgical therapy of Obstructive Sleep Apnea (OSA) requires addressing anatomical obstructions or collapse of the pharyngeal airway by skeletal and soft tissue surgeries. Numerous surgical options have been documented for OSA therapy with varying success. OSA surgery is vital when patients refuse continuous positive airway pressure (CPAP). The aim of this article is to review surgeries for OSA and the effectiveness of each surgery in terms of Epworth sleepiness scale (ESS), Apnea Hypopnea Index (AHI) or Respiratory Disturbance Index (RDI) reduction.

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Section: Maxillomandibular Advancementsupporting

confidence: 89%

Overview of Surgical Therapies for Obstructive Sleep Apnea: a Concise Review Literature

Suphangul

2020

Smj

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“…Among the studies, 31 were published as full‐text articles and were thus assessed in this meta‐analysis. Eleven studies described adults with OSA who received surgery and provided CRP measurements 23–33 . However, two studies by Marvisi et al and Vicente et al did not provide raw data required for meta‐analysis 23,24 ; their corresponding authors were contacted, but the data were still unavailable.…”

Section: Resultsmentioning

confidence: 99%

Effect of Sleep Surgery on C‐Reactive Protein Levels in Adults With Obstructive Sleep Apnea: A Meta‐Analysis

et al. 2020

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Objectives/Hypothesis To evaluate associations between sleep surgery and CRP (C‐reactive protein) levels in adults with obstructive sleep apnea (OSA). Study Design Meta‐analysis. Methods Two authors independently searched PubMed, Medline, EMBASE, and Cochrane review databases until July 2019. The keywords used were sleep apnea, OSA, sleep apnea syndromes, surgery, C‐reactive protein (CRP), and inflammatory markers. The effects of sleep surgery on CRP levels were examined using a random‐effects model. Results Nine studies with 277 patients were analyzed (mean age: 46.5 years; 92% men; mean sample size: 30.8 patients). The mean change in the apnea–hypopnea index (AHI) after surgery was significantly reduced by −21.1 (95% confidence interval [CI], −28.4 to −13.7) events/hr. Overall, sleep surgery resulted in a significant reduction of CRP levels in patients with OSA (standardized mean difference [SMD] = −0.39, 95% CI, −0.67 to −0.11). Patients with postoperative AHI reduction >20 events/hr achieved a greater reduction in CRP than those with AHI reduction <20 events/hr (SMD: −0.72 vs. −0.14, P for heterogeneity = .007). According to subgroup analysis, differences in the CRP levels after surgery were nonsignificant in the different countries (i.e., United States vs. other countries), CRP types (i.e., CRP vs. high‐sensitivity CRP), surgical procedures (i.e., pharyngeal surgery vs. other surgical procedures), and follow‐up period (i.e., <6 vs. >6 months). Conclusions Sleep surgery for OSA resulted in a significant reduction of CRP levels in adults. The beneficial effect of surgery on CRP levels is greater in patients with large improvement in OSA (i.e., AHI reduction >20 events/hr) after sleep surgery. Laryngoscope, 131:1180–1187, 2021

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“…127 Another example from a study of maxillomandibular advancement surgery showed a similar improvement in the total FOSQ score, with an increase from a mean score of 14.1 to 18.3. 138 In addition, a study on hypoglossal nerve stimulation with 126 patients found an improvement in total FOSQ score from 14.3 to 17.3. 103 By contrast, an RCT conducted by Marklund et al found no significant differences at follow-up in total FOSQ score or KSQ between MRD and a placebo device, though PSG improved.…”

Section: Study III -Sleep Quality After Uvulopalato-pharyngoplastymentioning

confidence: 99%

Eight‐Year Follow‐up of Modified Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea

et al. 2020

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Uvulopalatopharyngoplasty (UPPP) is the most common surgical treatment for adult patients with obstructive sleep apnea (OSA). Its short-term efficacy, as measured through polysomnography, is well-established and has been demonstrated in two randomized controlled trials in recent years. However, less is known about subjective sleep quality, longterm efficacy, and side effects after surgery. In addition, the reliability of the most widespread clinical test for selecting patients for surgery-the Friedman staging system-is unclear. The Friedman staging system uses a combination of tonsil size and tongue position to predict the likelihood of successful surgery. The objective of studies I and II was to evaluate the staging system by determining its inter-examiner agreement. In study I, 15 doctors evaluated the system by using it on each other. In study II, 14 doctors evaluated the system by using it on 12 patients with OSA. Cohen's kappa analysis was used. Kappa values of 1 represents perfect agreement, and values of 0 represent no more agreement than would have been expected through random chance. In study I, the median kappa was 0.36 for tongue position. In study II, the median kappa was 0.32 for tongue position, 0.62 for tonsil size, and 0.38 for the Friedman staging system. These findings correspond to poor agreement, indicating that the system is an uncertain method for selecting patients for UPPP. Uvulopalatopharyngoplasty was first described in the eighties. Since then, there has been several modifications. The modified UPPP used in this thesis includes a tonsillectomy and is performed with cold instruments. It is less radical to the palate compared to the original procedure. The objective of study III was to investigate whether modified UPPP improves sleep quality by using the Functional Outcomes of Sleep Questionnaire and the Karolinska Sleep Questionnaire. The study consisted of two parts: Part 1 was a randomized controlled trial with two study groups (intervention and controls), and Part 2 was a post-operative follow-up of all patients (intervention and controls who received delayed surgery) with an analysis of outcomes at six and 24 months after UPPP. In eight out of nine subscales, there were significant improvements between the intervention and controls in favor of UPPP. In addition, at the six-and 24-month post-operative follow-ups of all patients, eight out of nine subscales were significantly improved compared to the baseline. These findings suggest a real and lasting beneficial effect of UPPP on subjective sleep quality, although a placebo effect cannot be excluded.

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

Abstract: 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).

Cited by 36 publications

References 54 publications

Overview of Surgical Therapies for Obstructive Sleep Apnea: a Concise Review Literature

Overview of Surgical Therapies for Obstructive Sleep Apnea: a Concise Review Literature

Effect of Sleep Surgery on C‐Reactive Protein Levels in Adults With Obstructive Sleep Apnea: A Meta‐Analysis

Eight‐Year Follow‐up of Modified Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea

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