Maxillomandibular Advancement Surgery for Patients Who Are Refractory to Continuous Positive Airway Pressure: Are There Predictors of Success?

Makovey, Igor; Shelgikar, Anita Valanju; Stanley, Jeffrey J.; Robinson, Adina B.; Aronovich, Sharon

doi:10.1016/j.joms.2016.10.011

Cited by 6 publications

(6 citation statements)

References 35 publications

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“…Clinicians frequently encounter the presence of central and/or mixed events on PSG in patients with OSA, which makes the treatment decision-making process more difficult [ 39 ]. The results presented in this study on the CAI and its role with respect to the surgical success of MMA are in line with a study by Markovey et al [ 13 ], illustrating that a lower pre-operative CAI was a statistically significant predictor of surgical success (CAI pre-operatively in the success group was 0.6 versus 5.7 in the failure group, p -value = 0.005). Xie et al studied the difference between patients with pure OSA (100% of the apneas are obstructive) and predominant OSA (presence of both central and obstructive apneas and the obstructive apneas account for >50% of the total number of apneas), and they reported lower breathing control stability in patients with predominant OSA [ 40 ].…”

Section: Discussionsupporting

confidence: 91%

“…However, despite the high success rates, there is a group of patients who are considered as non-responders to MMA [ 12 ]. It is thought that the presence of complete anteroposterior collapse at the level of the epiglottis and a minimal retro velar space might contribute to MMA failure [ 13 , 14 ]. However, only a few studies have assessed predictors for failure in MMA; therefore, drawing conclusions remains arbitrary.…”

Section: Introductionmentioning

confidence: 99%

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Development and Internal Validation of a Prediction Model for Surgical Success of Maxillomandibular Advancement for the Treatment of Moderate to Severe Obstructive Sleep Apnea

Visscher

Zhou

et al. 2023

JCM

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Background: Maxillomandibular advancement (MMA) has been shown to be the most effective surgical therapy for obstructive sleep apnea (OSA). Despite high success rates, there are patients who are considered as non-responders to MMA. In order to triage and inform these patients on their expected prognosis of MMA before the surgery, this study aimed to develop, internally validate, and calibrate a prediction model for the presence of surgical success for MMA in patients with OSA. Methods: A retrospective cohort study was conducted that included patients that had undergone MMA for moderate to severe OSA. Baseline clinical, polysomnographic, cephalometric, and drug-induced sleep endoscopy findings were recorded as potential predictors. Presence or absence of surgical success was recorded as outcome. Binary logistic regression analyses were conducted to develop the model. Performance and clinical values of the model were analyzed. Results: One hundred patients were included, of which sixty-seven (67%) patients reached surgical success. Anterior lower face height (ALFH) (OR: 0.93 [0.87–1.00], p = 0.05), superior posterior airway space (SPAS) (OR: 0.76 [0.62–0.92], p < 0.05), age (OR: 0.96 [0.91–1.01], p = 0.13), and a central apnea index (CAI) <5 events/hour sleep (OR: 0.16 [0.03–0.91], p < 0.05) were significant independent predictors in the model (significance level set at p = 0.20). The model showed acceptable discrimination with a shrunken area under the curve of 0.74, and acceptable calibration. The added predictive values for ruling in and out of surgical success were 0.21 and 0.32, respectively. Conclusions: Lower age at surgery, CAI < 5 events/hour, lower ALFH, and smaller SPAS were significant predictors for the surgical success of MMA. The discrimination, calibration, and clinical added values of the model were acceptable.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Development and Internal Validation of a Prediction Model for Surgical Success of Maxillomandibular Advancement for the Treatment of Moderate to Severe Obstructive Sleep Apnea

Visscher

Zhou

et al. 2023

JCM

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“…The efficacy of rescue surgery to reduce DBP was also evaluated using a meta-analysis of 9 observational studies. 86,124,144,151,152,190,206,212,262 The meta-analysis demonstrated a clinically significant reduction in DBP of -2.7 mm Hg (95% CI: -7.9 to 2.5 mm Hg) with rescue therapy in adults with OSA (see supplemental material, Figure S18). The quality of evidence was low due to risk of bias associated with observational studies.…”

Section: Blood Pressurementioning

confidence: 97%

“…The efficacy of rescue surgery to reduce BP was evaluated using a an analysis of 1 RCT 38 and a meta-analysis of 10 observational studies. 86,124,144,151,152,190,206,212,219,262 The RCT 38 included mostly middle-aged participants with moderate to severe OSA who had failed conventional A c c e p t e d P a p e r treatment, and were allocated to multilevel upper airway surgery or medical management and followed for 6 months. The observational studies included retrospective, and prospective cohort and case-control designs.…”

Section: Blood Pressurementioning

confidence: 99%

Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment

Kent

Stanley

Aurora

et al. 2021

Journal of Clinical Sleep Medicine

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is listed as an inventor on US and international patent applications regarding surgical treatments for OSA owned and licensed by Vanderbilt University (VU) to Nyxoah SA. Dr. Kent receives a portion of any licensing revenues as per standard VU technology transfer policy. The licensed treatment methodologies do not currently exist in prototype or commercial form and are not represented in the surgical literature reviewed by the TF. The licensing agreement was completed in early 2021, after completion of the initial clinical practice guideline and supporting systematic review, and public comment period. Mr. Harrod is employed by the AASM. The other authors have not reported any conflicts of interest.

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“…For example, a meta-analysis suggested that younger age, lower baseline weight, lower baseline apnea hypopnea index [AHI], and greater degree of maxillary advancement were associated with increased surgical response [ 4 ]. In addition, a few studies also identified radiographic or drug-induced sleep endoscopy (DISE) predictors of surgical response to MMA [ 5 – 7 ], such as cephalometric minimum retrolingual space [ 6 ] and complete anteroposterior epiglottic collapse during DISE [ 7 ]. However, the evidence on predictors of MMA surgical outcome remains incomplete.…”

Section: Introductionmentioning

confidence: 99%

Maxillomandibular advancement for obstructive sleep apnea: a retrospective prognostic factor study for surgical response

Zhou

Visscher

et al. 2022

Sleep Breath

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Purpose To identify potential predictors of surgical response to maxillomandibular advancement (MMA) in patients with obstructive sleep apnea (OSA) from the most common clinically available data (patient-related, polysomnographic, cephalometric, and surgical variables). Methods This was a retrospective study comprised of consecutive patients who underwent MMA for moderate to severe OSA. Relevant clinical, polysomnographic, cephalometric, and surgical variables were collected as independent variables (predictors). The association of the independent variables with a favorable surgical response to MMA was assessed in univariate and multivariate analyses. Results In 100 patients (82% male; mean age 50.5 years), the mean apnea hypopnea index [AHI] was 53.1 events/h. The rate of favorable surgical response was 67%. Based on multivariate analysis, patients with cardiovascular disease (CVD) had 0.140 times lower odds of a favorable response to MMA (OR: 0.140 [0.038, 0.513], P = 0.003). For each 1-unit increase in central apnea index (CAI) and superior posterior airway space (SPAS), there were 0.828 and 0.724 times lower odds to respond favorably to MMA (OR: 0.828 [0.687, 0.997], P = 0.047; and 0.724 [0.576, 0.910], P = 0.006), respectively. Conclusion The findings of this study suggest that the surgical outcome of MMA may be less favorable when patients with OSA have certain phenotypic characteristics: the presence of CVD, higher CAI and larger SPAS. If confirmed in future studies, these variables may guide patient selection for MMA.

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Maxillomandibular Advancement Surgery for Patients Who Are Refractory to Continuous Positive Airway Pressure: Are There Predictors of Success?

Cited by 6 publications

References 35 publications

Development and Internal Validation of a Prediction Model for Surgical Success of Maxillomandibular Advancement for the Treatment of Moderate to Severe Obstructive Sleep Apnea

Development and Internal Validation of a Prediction Model for Surgical Success of Maxillomandibular Advancement for the Treatment of Moderate to Severe Obstructive Sleep Apnea

Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment

Maxillomandibular advancement for obstructive sleep apnea: a retrospective prognostic factor study for surgical response

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