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Camacho M, Teixeira J, Abdullatif J, Acevedo JL, Certal V, Capasso R, Powell NB. Maxillomandibular Advancement and Tracheostomy for Morbidly Obese Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2015; 152:619-30. [DOI: 10.1177/0194599814568284] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 12/23/2014] [Indexed: 11/15/2022]
Abstract
Objective The objective of this study is to systematically review polysomnography data and sleepiness in morbidly obese (body mass index [BMI] ≥40 kg/m2) patients with obstructive sleep apnea (OSA) treated with either a maxillomandibular advancement (MMA) or a tracheostomy and to evaluate the outcomes. Data Sources MEDLINE, Scopus, Web of Science, and the Cochrane Library. Review Methods A search was performed from inception through April 8, 2014, in each database. Results Six maxillomandibular advancement studies (34 patients, age 42.42 ± 9.13 years, mean BMI 44.88 ± 4.28 kg/m2) and 6 tracheostomy studies (14 patients, age 52.21 ± 10.40 years, mean BMI 47.93 ± 7.55 kg/m2) reported individual patient data. The pre- and post-MMA means ± SDs for apnea-hypopnea indices were 86.18 ± 33.25/h and 9.16 ± 7.89/h ( P < .00001), and lowest oxygen saturations were 66.58% ± 16.41% and 87.03% ± 5.90% ( P < .00001), respectively. Sleepiness following MMA decreased in all 5 patients for whom it was reported. The pre- and posttracheostomy mean ± SD values for apnea indices were 64.43 ± 41.35/h and 1.73 ± 2.68/h ( P = .0086), oxygen desaturation indices were 69.20 ± 26.10/h and 41.38 ± 36.28/h ( P = .22), and lowest oxygen saturations were 55.17% ± 16.46% and 79.83% ± 4.36% ( P = .011), respectively. Two studies reported outcomes for Epworth Sleepiness Scale for 5 patients, with mean ± SD values of 18.80 ± 4.02 before tracheostomy and 2.80 ± 2.77 after tracheostomy ( P = .0034). Conclusion Data for MMA and tracheostomy as treatment for morbidly obese, adult OSA patients are significantly limited. We caution surgeons about drawing definitive conclusions from these limited studies; higher level studies are needed.
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Affiliation(s)
- Macario Camacho
- Sleep Medicine Division, Stanford Hospital and Clinics, Redwood City, California, USA
| | - Jeffrey Teixeira
- US Army, Department of Otolaryngology–Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jose Abdullatif
- Department of Otorhinolaryngology, Hospital Bernardino Rivadavia, Buenos Aires, Argentina
| | - Jason L. Acevedo
- US Army, Department of Otolaryngology–Head and Neck Surgery, Reynolds Army Community Hospital, Fort Sill, Oklahoma, USA
| | - Victor Certal
- Department of Otorhinolaryngology/Sleep Medicine Centre–Hospital CUF, Porto, Portugal
- CINTESIS–Centre for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal
| | - Robson Capasso
- Department of Otolaryngology–Head and Neck Surgery, Sleep Surgery Division, Stanford University Medical Center, Stanford, California, USA
| | - Nelson B. Powell
- Department of Otolaryngology–Head and Neck Surgery, Sleep Surgery Division, Stanford Hospital and Clinics, Stanford, California, USA
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