1
|
Tegelberg Å, Nohlert E, List T, Isacsson G. Oral appliance influence on jaw function in obstructive sleep apnea. Am J Orthod Dentofacial Orthop 2023; 164:682-689. [PMID: 37318425 DOI: 10.1016/j.ajodo.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/01/2023] [Accepted: 04/01/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Oral appliance (OA) therapy in obstructive sleep apnea (OSA) could be a risk factor for normal jaw function, given the prolonged effect of an OA in keeping the mandible in a protruded position away from a normal position. This study aimed to assess changes in symptoms and clinical findings related to jaw function after 1 year of treating OSA with an OA. METHODS In this follow-up clinical trial, 302 patients with OSA were assigned to treatment with either monobloc or bibloc OA. Baseline and 1-year follow-up assessment included using the Jaw Functional Limitation Scale, self-reported symptoms and signs related to jaw function. The clinical examination of jaw function included mandibular mobility, dental occlusion, and tenderness in the temporomandibular joints and masticatory muscles. Descriptive analyses of variables are presented for the per-protocol population. To evaluate differences between the baseline and the 1-year follow-up, paired Student t tests and the McNemar change test was used. RESULTS One-hundred and ninety-two patients completed the 1-year follow-up (male 73%, mean aged 55 ± 11 years). There was no change in the Jaw Functional Limitation Scale score at the follow-up (nonsignificant). The patients described no change in symptoms at the follow-up, except for improvements in morning headache (P <0.001) and increased frequency of difficulties in opening the mouth or chewing on awakening (P = 0.002). Subjectively reported changes in dental occlusion during biting/chewing increased significantly at the follow-up (P = 0.009). CONCLUSIONS No changes in measurements of jaw mobility, dental occlusion, or pain on palpation of the temporomandibular joints or masticatory muscles were seen at the follow-up. Thus, using an OA in treating OSA had limited influence on jaw functions and related symptoms. Moreover, the risk of developing pain and functional impairment in the masticatory system was infrequent, indicating that this treatment is safe and can be recommended.
Collapse
Affiliation(s)
- Åke Tegelberg
- Department of Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden; Region Västmanland - Uppsala University, Centre for Clinical Research, Västmanland Hospital, Västerås, Sweden.
| | - Eva Nohlert
- Region Västmanland - Uppsala University, Centre for Clinical Research, Västmanland Hospital, Västerås, Sweden
| | - Thomas List
- Department of Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden
| | - Göran Isacsson
- Region Västmanland - Uppsala University, Centre for Clinical Research, Västmanland Hospital, Västerås, Sweden; Orofacial pain and jaw function Clinic, Department of Specialist Dental Care, Västmanland Hospital, Västerås, Sweden
| |
Collapse
|
2
|
Belkhode V, Godbole S, Nimonkar S, Pisulkar S, Nimonkar P. Comparative evaluation of the efficacy of customized maxillary oral appliance with mandibular advancement appliance as a treatment modality for moderate obstructive sleep apnea patients-a randomized controlled trial. Trials 2023; 24:73. [PMID: 36726182 PMCID: PMC9890424 DOI: 10.1186/s13063-022-07054-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/27/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is quite common among the adult population, according to recent epidemiological studies. The most frequently suggested alternate treatment for mild to moderate OSA is oral appliances (OA). The purpose of the present study was to assess as well as compare the effectiveness of custom-made maxillary oral appliances against mandibular advancement appliances in the care of individuals suffering from moderate obstructive sleep apnea. METHODS A prospective interventional research was carried out with 40 participants. Polysomnography (PSG) was done and the participants with an apnea-hypopnea index (AHI) >15-30 were involved in the research. Study participants were randomly split up into two test groups: group I was the "Control Group" (group treated with a mandibular advancement device (MAD), n=20), while group II was exposed to a "customized maxillary oral appliance" (CMOA, n=20). Both groups had reference measures for AHI, blood oxygen saturation (SpO2), oro-nasal airflow via respiratory disturbance index (RDI), and the Epworth Sleepiness Scale (ESS). Appliances were fabricated and delivered to the respective study group participants. PSG was again conducted after a period of 1 and 3 months of appliance delivery and re-evaluation was done for all the parameters and was compared with reference measurements. The facts were analyzed using descriptive and analytical statistical methods. The statistical program utilized in the study was "SPSS (Statistical Package for Social Sciences) Version 20.1." After 1 and 3 months, the statistical significance between the two study groups was assessed at P<0.05. RESULTS The analysis of mean AHI, SPO2, RDI, and ESS for both test groups manifested statistically significant measures (P<0.001). The study results revealed a statistically significant depletion in mean AHI scores, improvement in mean SPO2 scores, and reduction in mean RDI scores and ESS scores when compared with reference measurements to 1 month, 1 to 3 months, and between reference measurements and 3 months. CONCLUSION The CMOA was effective in managing moderate OSA and has great therapeutic potential. It can be an option for the MAD for treating patients suffering from moderate obstructive sleep apnea. TRIAL REGISTRATION The study was registered under Clinical Trials Registry-India and the registration number is CTRI/2020/07/026936 . Registered on 31 July 2020.
Collapse
Affiliation(s)
- Vikram Belkhode
- grid.413489.30000 0004 1793 8759Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Deemed to be University, Sawangi, Wardha, Maharashtra India ,Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, Wardha, India
| | - Surekha Godbole
- Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, Wardha, India ,grid.413489.30000 0004 1793 8759Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra India
| | - Sharayu Nimonkar
- Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, Wardha, India ,grid.413489.30000 0004 1793 8759Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra India ,New SBI Colony NisargNagri, Nagpur Road, Wardha, 442001 India
| | - Sweta Pisulkar
- grid.413489.30000 0004 1793 8759Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra India ,grid.413213.60000 0004 1793 9671Trauma Care Centre, Government Medical College, Nagpur, Maharashtra India
| | - Pranali Nimonkar
- grid.413213.60000 0004 1793 9671Trauma Care Centre, Government Medical College, Nagpur, Maharashtra India
| |
Collapse
|
3
|
Belkhode V, Godbole S, Nimonkar S, Nimonkar P, Pisulkar S. Comparative evaluation of the efficacy of customized maxillary oral appliance with mandibular advancement appliance as a treatment modality for moderate obstructive sleep apnea patients-protocol for a randomized controlled trial. Trials 2022; 23:159. [PMID: 35172870 PMCID: PMC8848661 DOI: 10.1186/s13063-022-06070-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is due to the obstruction of the upper airway during sleep. This condition is often associated with multiple symptoms and co-morbidities. There are many treatment options mentioned in the literature to manage OSA, among which interventional option of continuous positive airflow (CPAP) and non-interventional option, i.e., mandibular advancement device (MAD), which is an oral appliance (OA), are the most preferred ones. This study aims to evaluate the efficacy of customized maxillary oral appliances with mandibular advancement devices in moderate OSA patients. Methods A prospective interventional study with a randomized controlled trial will be carried out involving 40 participants (sample size), with an apnea-hypopnea index (AHI) > 15–30, recorded on polysomnography (PSG). Study participants will be randomly divided into the following treatment groups: control group or group subjected to mandibular advancement device (MAD, n=20) and second group subjected to customized maxillary oral appliance (CMOA, n=20). Baseline assessment of apnea/hypopnea index (AHI), oxygen saturation in blood, percentage of rapid eye movement, electroencephalogram, electrocardiogram, oro-nasal airflow via a pressure transducer, and Epworth Sleepiness Scale will be done. Then both study group participants will receive their respective appliances. And after one month and three months of delivery of the appliance, all the parameters, i.e., AHI, oxygen saturation in blood, percentage of rapid eye movement, electroencephalogram, electrocardiogram, oro-nasal airflow via a pressure transducer, and Epworth Sleepiness Scale will be re-evaluated and compared with the baseline measurements. Descriptive and analytical statistics will be done. SPSS (Statistical Package for Social Sciences) Version 20.1 will be used as statistical software. The statistical significance between the two groups after one month and three months will be evaluated at p< 0.05. Discussion We expect, customized maxillary oral appliance to be more efficient in managing moderate OSA, in comparison with MAD. If the hypothesis of the present study is confirmed, then this customized maxillary appliance will be quoted as a “gold standard” for managing moderate OSA. Trial registration CTRI/2020/07/026936 Registered 31 July 2020.
Collapse
Affiliation(s)
- Vikram Belkhode
- Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (Meghe), Wardha, Maharashtra, India
| | - Surekha Godbole
- Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (Meghe), Wardha, Maharashtra, India
| | - Sharayu Nimonkar
- Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (Meghe), Wardha, Maharashtra, India.
| | - Pranali Nimonkar
- Trauma Care Centre, Government Medical College, Nagpur, Maharashtra, India
| | - Sweta Pisulkar
- Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (Meghe), Wardha, Maharashtra, India
| |
Collapse
|
4
|
Objective and subjective long term outcome of maxillomandibular advancement in obstructive sleep apnea. Sleep Med 2020; 74:289-296. [DOI: 10.1016/j.sleep.2020.05.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 11/23/2022]
|
5
|
Lee KH, Kim KA, Kwon YD, Kim SW, Kim SJ. Maxillomandibular advancement surgery after long-term use of a mandibular advancement device in a post-adolescent patient with obstructive sleep apnea. Korean J Orthod 2019; 49:265-276. [PMID: 31367581 PMCID: PMC6658904 DOI: 10.4041/kjod.2019.49.4.265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/31/2018] [Accepted: 12/03/2018] [Indexed: 11/24/2022] Open
Abstract
Patients with obstructive sleep apnea (OSA) whose phenotype belongs to a craniofacial vulnerability are referred from sleep doctors to orthodontists. In adults, for osseo-pharyngeal reconstruction (OPR) treatment, permanent maxillomandibular advancement (MMA) surgery and use of a temporary mandibular advancement device (MAD) are applied. This case report demonstrates successful treatment of OSA through application of phased MAD and MMA in a 16-year-old male with craniofacial deformity and residual growth potential. This patient showed skeletal and dentoalveolar changes after 7-year MAD use throughout post-adolescence, which affected the design and timing of subsequent MMA surgery, as well as post-surgical orthodontic strategy. This case report suggests that OPR treatment can be useful for treatment of OSA in post-adolescent patients, from an orthodontic point of view, in close collaboration with sleep doctors for interdisciplinary diagnosis and treatment.
Collapse
Affiliation(s)
- Keun-Ha Lee
- Department of Orthodontics, Kyung Hee University Graduate School, Seoul, Korea
| | - Kyung-A Kim
- Department of Orthodontics, Kyung Hee University School of Dentistry, Seoul, Korea
| | - Yong-Dae Kwon
- Department of Oral and Maxillofacial Surgery, Kyung Hee University School of Dentistry, Seoul, Korea
| | - Sung-Wan Kim
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Su-Jung Kim
- Department of Orthodontics, Kyung Hee University School of Dentistry, Seoul, Korea
| |
Collapse
|
6
|
Camacho M, Noller MW, Del Do M, Wei JM, Gouveia CJ, Zaghi S, Boyd SB, Guilleminault C. Long-term Results for Maxillomandibular Advancement to Treat Obstructive Sleep Apnea: A Meta-analysis. Otolaryngol Head Neck Surg 2019; 160:580-593. [DOI: 10.1177/0194599818815158] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To examine outcomes in the intermediate term (1 to <4 years), long term (4 to <8 years), and very long term (≥8 years) for maxillomandibular advancement (MMA) as treatment for obstructive sleep apnea (OSA). Data Sources The Cochrane Library, Google Scholar, Embase, Cumulative Index to Nursing and Allied Health, and PubMed/MEDLINE. Review Methods Three authors systematically reviewed the international literature through July 26, 2018. Results A total of 445 studies were screened, and 6 met criteria (120 patients). Thirty-one patients showed a reduction in apnea-hypopnea index (AHI) from a mean 48.3 events/h (95% CI, 42.1-54.5) pre-MMA to 8.4 (95% CI 5.6, 11.2) in the intermediate term. Fifty-four patients showed a reduction in AHI from a mean 65.8 events/h (95% CI, 58.8-72.8) pre-MMA to 7.7 (95% CI 5.9, 9.5) in the long term. Thirty-five showed a reduction in AHI from a mean 53.2 events/h (95% CI 45, 61.4) pre-MMA to 23.1 (95% CI 16.3, 29.9) in the very long term. Improvement in sleepiness was maintained at all follow-up periods. Lowest oxygen saturation improvement was maintained in the long term. Conclusion The current international literature shows that patients with OSA who were treated with MMA maintained improvements in AHI, sleepiness, and lowest oxygen saturation in the long term; however, the mean AHI increased to moderate OSA in the very long term. Definitive generalizations cannot be made, and additional research providing individual patient data for the intermediate term, long term, and very long term is needed.
Collapse
Affiliation(s)
- Macario Camacho
- Division of Sleep Surgery and Sleep Medicine, Department of Otolaryngology–Head and Neck Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii, USA
| | - Michael W. Noller
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Michael Del Do
- Department of Otolaryngology–Head and Neck Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii, USA
| | - Justin M. Wei
- Department of Otolaryngology–Head and Neck Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii, USA
| | - Christopher J. Gouveia
- Department of Otolaryngology–Head and Neck Surgery, Kaiser Permanente - Santa Clara, Santa Clara, California, USA
| | - Soroush Zaghi
- UCLA Medical Center–Santa Monica, University of California–Los Angeles, Santa Monica, California, USA
| | - Scott B. Boyd
- Department of Oral and Maxillofacial Surgery, School of Medicine, Retired Faculty, Vanderbilt University, Nashville, Tennessee, USA
| | - Christian Guilleminault
- Sleep Medicine Division, Department of Psychiatry, Stanford Hospital and Clinics, Redwood City, California, USA
| |
Collapse
|
7
|
Kuk TS, So E, Karm MH, Kim J, Chi SI, Kim HJ, Seo KS, On SW, Choi JY. Anesthetic management for simultaneous drug-induced sleep endoscopy and maxillomandibular advancement in a patient with obstructive sleep apnea. J Dent Anesth Pain Med 2017; 17:71-76. [PMID: 28879332 PMCID: PMC5564140 DOI: 10.17245/jdapm.2017.17.1.71] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 03/23/2017] [Accepted: 03/25/2017] [Indexed: 11/15/2022] Open
Abstract
Drug-induced sleep endoscopy (DISE) is used to identify areas of upper airway obstruction, which occurs when patients with obstructive sleep apnea (OSA) snore. DISE enables effective diagnosis and appropriate treatment of the obstruction site. Among surgical treatment methods for OSA, maxillomandibular advancement surgery (MMA) is performed to move a jaw forward; the surgery has a high success rate for OSA treatment. In DISE, anesthetics such as propofol and midazolam must be administered to induce snoring while the patient is deeply sedated for an accurate diagnosis to be made. When inducing deep sedation in a patient with OSA, airway obstruction may increase, causing oxygen saturation to drop; airway interventions are necessary in such cases. Effective DISE and MMA surgery can be performed by administering propofol through target-controlled infusion while monitoring the bispectral index (BIS).
Collapse
Affiliation(s)
- Tae Seong Kuk
- Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Korea
| | - Eunsun So
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Myong-Hwan Karm
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Jimin Kim
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Seong In Chi
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Hyun Jeong Kim
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Sung Woon On
- Division of Oral and Maxillofacial surgery, Department of Dentistry, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Jin-Young Choi
- Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Korea
| |
Collapse
|
8
|
SANTIAGO TM, MOURA LB, GABRIELLI MAC, SPIN-NETO R, PEREIRA-FILHO VA. Volumetric and cephalometric evaluation of the upper airway of class III patients submitted to maxillary advancement. REVISTA DE ODONTOLOGIA DA UNESP 2016. [DOI: 10.1590/1807-2577.05816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Abstract Introduction Anteroposterior maxillary deficiency can be associated with a decrease of upper airway volume. Maxillary advancement can improve the upper airway space. Aim To correlate cephalometric (2D) and volumetric (3D) measurements of the upper airway in class III patients treated by maxillary advancement. Material and method This retrospective transversal study was performed in ten adult patients submitted to maxillary advancement for correction of class III deformity secondary to maxillary anteroposterior deficiency. The Cone beam tomography files included in the medical records were used: (T1) pre-operative and (T2) 6 to 8 months postoperative. The DICOM files were imported and reconstructed for volumetric and cephalometric evaluation of the upper airway, as divided into nasopharynx, oropharynx and hypopharynx (Arnett & Gunson FAB Surgery). Result Age ranged from 26 to 55 years with a mean of 36.3±9.2 years. There were no statistically significant differences for cephalometric and volumetric parameters of the three pharyngeal regions between T1 and T2 periods. This was due to the small amount of maxillary advancement necessary to correct the maxillary deformity in the studied patients (4.7±1.89mm). The correlation between area and volume was not statistically significant only for preoperative measurements of the nasopharynx (r=0.30, p=0.40). It was significant for the other regions and evaluation periods (p<0.05). Conclusion Small maxillary advancements do not result in significant increases in airway dimensions.
Collapse
|
9
|
Başal Y, Akyıldız UO, Eryilmaz A. Combined surgical treatment for severe sleep apnoea, to improve BiPAP compliance. BMJ Case Rep 2015; 2015:bcr-2015-212143. [PMID: 26546622 DOI: 10.1136/bcr-2015-212143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Positive airway pressure (PAP) devices are used in the treatment of obstructive sleep apnoea syndrome (OSAS). In cases of PAP failure, many different surgical methods can be used for the treatment. The authors present an unusual case of a patient with Bi-level PAP (BiPAP)-intolerant severe OSAS who was treated with combined surgical methods. A 55-year-old man was treated with BiPAP due to OSAS; he was admitted to the clinic with nose stuffiness, respiratory distress and BiPAP adherence with tolerance and compliance problems. Septal deviation, concha hypertrophy, lateral pharyngeal band hypertrophy and Thornwaldt cyst were determined in the examination. Combined surgical methods were administered. The patient's apnoea hypopnoea index (AHI) was 72.8 in diagnostic polysomnography. Preoperative AHI was 7.3 and postoperative AHI was 2.3 while using BiPAP and, after the surgery, the BiPAP intolerance was eliminated. The authors suggest that a combination of different surgical methods would be an adjuvant treatment to increase BiPAP compliance.
Collapse
Affiliation(s)
- Yeşim Başal
- Department of Otorhinolaryngology, Adnan Menderes University, Aydin, Turkey
| | | | - Aylin Eryilmaz
- Department of Otorhinolaryngology, Adnan Menderes University, Aydin, Turkey
| |
Collapse
|
10
|
Boyd SB, Walters AS, Waite P, Harding SM, Song Y. Long-Term Effectiveness and Safety of Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea. J Clin Sleep Med 2015; 11:699-708. [PMID: 25766718 DOI: 10.5664/jcsm.4838] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/07/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVE To determine the long-term clinical effectiveness and safety of maxillomandibular advancement (MMA) for the treatment of moderate to severe obstructive sleep apnea (OSA). METHODS A prospective two-center cohort study design was used to evaluate OSA patients who underwent MMA > 2 years ago. The primary outcome measure was the apnea-hypopnea index (AHI). Secondary outcome measures included blood pressure (BP), sleepiness (Epworth Sleepiness Scale [ESS]), and quality of life (Functional Outcomes of Sleep Questionnaire [FOSQ]). RESULTS 30 adult patients (80% men, age 50.5 ± 9.6 years [mean ± SD]) participated in the study. The AHI decreased from a mean of 49 to 10.9 events/h (p < 0.0001) at the time of long-term evaluation (6.6 ± 2.8 years after MMA), with 46.7% of patients obtaining an AHI < 5 and 83.4% of patients attaining an AHI ≤ 15 events/h. The mean diastolic BP decreased from 83.7 to 79.0 mm Hg (p < 0.05). ESS decreased from a mean of 12.1 to 6.0 (p < 0.01). FOSQ increased from a mean of 12.6 to 17.3 (p < 0.05). Few long-term treatment-related adverse events occurred, which had minimal impact on quality of life (QOL). CONCLUSIONS MMA is a clinically effective and safe long-term treatment for most patients with moderate-to-severe OSA as demonstrated by significant decreases in AHI, diastolic BP, and subjective sleepiness, with concomitant significant improvements in QOL. The results of this small cohort study suggest that MMA should be considered as the alternative treatment of choice for patients with severe OSA who cannot fully adhere to CPAP therapy.
Collapse
Affiliation(s)
- Scott B Boyd
- Department of Neurology, Sleep Disorders Division, Vanderbilt University School of Medicine, Nashville, TN.,Department of Oral and Maxillofacial Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Arthur S Walters
- Department of Neurology, Sleep Disorders Division, Vanderbilt University School of Medicine, Nashville, TN
| | - Peter Waite
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Susan M Harding
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Yanna Song
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| |
Collapse
|
11
|
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: 2.7] [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.
Collapse
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
| |
Collapse
|