Volume 160, Issue 4 p. 580-593
Review Articles

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

Macario Camacho MD

Corresponding Author

Macario Camacho MD

Division of Sleep Surgery and Sleep Medicine, Department of Otolaryngology–Head and Neck Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii, USA

Corresponding Author: Macario Camacho, MD, Division of Sleep Surgery and Sleep Medicine, Department of Otolaryngology–Head and Neck Surgery, Tripler Army Medical Center, 1 Jarrett White Rd, Tripler AMC, HI 96859. Email: [email protected]Search for more papers by this author
Michael W. Noller MD

Michael W. Noller MD

Walter Reed National Military Medical Center, Bethesda, Maryland, USA

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Michael Del Do MD

Michael Del Do MD

Department of Otolaryngology–Head and Neck Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii, USA

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Justin M. Wei MD

Justin M. Wei MD

Department of Otolaryngology–Head and Neck Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii, USA

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Christopher J. Gouveia MD

Christopher J. Gouveia MD

Department of Otolaryngology–Head and Neck Surgery, Kaiser Permanente - Santa Clara, Santa Clara, California, USA

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Soroush Zaghi MD

Soroush Zaghi MD

UCLA Medical Center–Santa Monica, University of California–Los Angeles, Santa Monica, California, USA

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Scott B. Boyd DDS, PhD

Scott B. Boyd DDS, PhD

Department of Oral and Maxillofacial Surgery, School of Medicine, Retired Faculty, Vanderbilt University, Nashville, Tennessee, USA

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Christian Guilleminault MD

Christian Guilleminault MD

Sleep Medicine Division, Department of Psychiatry, Stanford Hospital and Clinics, Redwood City, California, USA

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First published: 01 January 2019
Citations: 24
No sponsorships or competing interests have been disclosed for this article.
The views expressed in this abstract/manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US government.

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.