scholarly journals 0588 RELATIONSHIP BETWEEN PHARYNGEAL VOLUME AND APNEA HYPOPNEA INDEX AFTER MAXILLOMANDIBULAR ADVANCEMENT SURGERY IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA

SLEEP ◽  
2017 ◽  
Vol 40 (suppl_1) ◽  
pp. A218-A218
Author(s):  
AC Faria ◽  
AL Eckeli ◽  
DM Garcia ◽  
FV Mello-Filho
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Maxillomandibular Advancement ◽  
Obstructive Sleep

Long-term Results for Maxillomandibular Advancement to Treat Obstructive Sleep Apnea: A Meta-analysis

2019 ◽  
Vol 160 (4) ◽  
pp. 580-593 ◽  
Author(s):  
Macario Camacho ◽  
Michael W. Noller ◽  
Michael Del Do ◽  
Justin M. Wei ◽  
Christopher J. Gouveia ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oxygen Saturation ◽  
Long Term Results ◽  
Cochrane Library ◽  
Apnea Hypopnea Index ◽  
International Literature ◽  
Maxillomandibular Advancement ◽  
Obstructive Sleep

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.

Polysomnographic Outcomes Before and After Skeletal Surgeries for the Treatment of Obstructive Sleep Apnea

2021 ◽  
Vol 104 (3) ◽  
pp. 445-452
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Success Rates ◽  
Maxillomandibular Advancement ◽  
Obstructive Sleep ◽  
Before And After ◽  
Hyoid Suspension ◽  
Group 2 ◽  
Osa Treatment

Objective: To evaluate polysomnographic (PSG) outcomes after common skeletal surgeries for the treatment of obstructive sleep apnea (OSA) in Thai patients. Materials and Methods: The retrospective study included OSA patients aged 18 years and older treated by hyoid suspension (HS) plus uvulopalatopharyngoplasty (UPPP) (Group 1), genioglossus advancement (GA) plus tongue base radiofrequency (TBRF) (Group 2), and maxillomandibular advancement (MMA) (Group 3) at Siriraj Hospital between January 2007 and October 2018. Those with incomplete PSG data were excluded. The primary outcome was the apnea-hypopnea index (AHI). Secondary outcomes were other PSG parameters and postoperative complications. Results: Twenty-four patients including 22 males and 2 females were included. Group1 (n=11), median AHI decreased from 45.4 to 24.1 events/hour (p=0.17), while lowest oxygen saturation (LSAT) changed from 72.0% to 71.0% (p=0.11). Group2 (n=3) median AHI decreased from 64.7 to 51.4 events/hour (p=0.11), LSAT increased from 76.0% to 79.0% (p=1.0), and rapid eye movement (REM) sleep increased from 0.0% to 12.4% (p=0.11). Group3 (n=12) median AHI decreased from 68.5 to 7.8 events/hour (p<0.002), LSAT increased from 75.5% to 88.0% (p=0.04), and REM increased from 0.0% to 21.5% (p=0.01). Surgical success rates as defined by Sher’s criteria or a postoperative AHI of less than five events/hour were 44.4%, 33.3%, and 66.6% in patients in groups 1, 2, and 3, respectively. Common surgical complications included bleeding, mental or perioral paresthesia, and malocclusion after MMA. Conclusion: The skeletal surgeries significantly improved some PSG parameters, and thus may be viable options for OSA treatment in Thai patients. Keywords: Obstructive sleep apnea, Skeletal surgery, Hyoid suspension, Genioglossus advancement, Maxillomandibular advancement, Thai

scholarly journals Maxillomandibular Advancement in the Management of Obstructive Sleep Apnea

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Ranji Varghese ◽  
Nathan G. Adams ◽  
Nancy L. Slocumb ◽  
Christopher F. Viozzi ◽  
Kannan Ramar ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Le Fort ◽  
Post Surgery ◽  
Maxillomandibular Advancement ◽  
Obstructive Sleep ◽  
Maxilla And Mandible ◽  
Le Fort I ◽  
Surgical Option

Maxillomandibular advancement (MMA) is a surgical option for obstructive sleep apnea (OSA). MMA involves forward-fixing the maxilla and mandible approximately 10  mm via Le Fort I maxillary and sagittal split mandibular osteotomies. We retrospectively reviewed outcomes from 24 consecutive OSA patients who underwent MMA at our institution. MMA resulted in an 83% reduction in the group mean apnea-hypopnea index (AHI) per polysomnography an average of 6.7 months after surgery. Forty-two percent of patients achieved a post-MMA AHI of less than 5 events/hour sleep and 71% achieved an AHI less than or equal to 10 events/hour sleep. The Epworth Sleepiness Scale score decreased by an average of 5 post-surgery. No parameters predictive of cure for OSA by MMA were identified.

scholarly journals Effects of maxillomandibular advancement surgery on a skeletal Class III patient with obstructive sleep apnea: A case report

2021 ◽  
Vol 11 ◽  
pp. 161-168
Author(s):  
Ghaddy AlSaty ◽  
Mary Burns ◽  
Peter Ngan
Keyword(s):  
Obstructive Sleep Apnea ◽  
Case Report ◽  
Sleep Apnea ◽  
Definitive Treatment ◽  
Radiographic Examination ◽  
Apnea Hypopnea Index ◽  
Class Iii ◽  
Lateral Cephalogram ◽  
Maxillomandibular Advancement ◽  
Obstructive Sleep

This case report describes the successful surgical treatment of a patient diagnosed with obstructive sleep apnea (OSA). A 55-year-old Caucasian male patient with a body mass index (BMI) of 25.6 kg/m2 sought treatment with a chief concern of excessive daytime sleepiness and fatigue. An initial polysomnography report showed moderate OSA with an apnea-hypopnea index (AHI) of 21.2 events/h, and Epworth Sleepiness Score (ESS) of 12/24. The patient was initially prescribed with CPAP treatment but was unable to tolerate treatment after a few months. Clinical and radiographic examination revealed a concave facial profile with maxillary retrognathism. Intraoral examination revealed generalized gingival recession, missing upper lateral incisors and lower first premolars, anterior crossbite, and maxillary transverse deficiency with bilateral posterior crossbite. The lateral cephalogram showed a narrow posterior airway space at the level of the base of the tongue. The patient was treated with maxillomandibular advancement (MMA) surgery to improve airway obstruction. Results showed balanced facial esthetic and stable occlusion with a complete resolution of the patient’s OSA and a post-operative improvement of AHI from 21.2 to 0.7 events/h and ESS from 12/24 to 3/24. The lowest oxyhemoglobin saturation during sleep was improved to 97%, and the BMI decreased from 25.6 to 25.2 kg/m2. These results suggest that MMA surgical procedure can be used as a definitive treatment for patients with maxillomandibular deficiency and OSA.

Improvement in Obstructive Sleep Apnea (OSA) in Super Morbidly Obese Patients After Bariatric Surgery

2020 ◽  
Vol 103 (8) ◽  
pp. 725-728
Keyword(s):  
Bariatric Surgery ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Lifestyle Modification ◽  
Apnea Hypopnea Index ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Obstructive Sleep ◽  
Objective Evidence

Background: Lifestyle modification is the mainstay therapy for obese patients with obstructive sleep apnea (OSA). However, most of these patients are unable to lose the necessary weight, and bariatric surgery (BS) has been proven to be an effective modality in selected cases. Objective: To provide objective evidence that BS can improve OSA severity. Materials and Methods: A prospective study was conducted in super morbidly obese patients (body mass index [BMI] greater than 40 kg/m² or BMI greater than 35 kg/m² with uncontrolled comorbidities) scheduled for BS. Polysomnography (PSG) was performed for preoperative assessment and OSA was treated accordingly. After successful surgery, patients were invited to perform follow-up PSG at 3, 6, and 12 months. Results: Twenty-four patients with a mean age of 35.0±14.0 years were enrolled. After a mean follow-up period of 7.8±3.4 months, the mean BMI, Epworth sleepiness scale (ESS), and apnea-hypopnea index (AHI) significantly decreased from 51.6±8.7 to 38.2±6.8 kg/m² (p<0.001), from 8.7±5.9 to 4.7±3.5 (p=0.003), and from 87.6±38.9 to 28.5±21.5 events/hour (p<0.001), respectively. Conclusion: BS was shown to dramatically improve clinical and sleep parameters in super morbidly obese patients. Keywords: Morbid obesity, Bariatric surgery, Obstructive sleep apnea (OSA)

Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction

ORL ◽  
2021 ◽  
pp. 1-8
Author(s):  
Lifeng Li ◽  
Demin Han ◽  
Hongrui Zang ◽  
Nyall R. London
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nasal Obstruction ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Nasal Surgery ◽  
Subjective Sleep Quality ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
The Impact

<b><i>Objective:</i></b> The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. <b><i>Methods:</i></b> Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. <b><i>Results:</i></b> By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (<i>p</i> &#x3c; 0.05), while the Apnea-Hypopnea Index (AHI) changed little (<i>p</i> = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all <i>p</i> &#x3c; 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (<i>p</i> &#x3c; 0.05), except with the AHI (<i>p</i> &#x3e; 0.05). <b><i>Conclusion:</i></b> Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.

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