Long-term Results for Maxillomandibular Advancement to Treat Obstructive Sleep Apnea: A Meta-analysis
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 authorMichael W. Noller MD
Walter Reed National Military Medical Center, Bethesda, Maryland, USA
Search for more papers by this authorMichael Del Do MD
Department of Otolaryngology–Head and Neck Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii, USA
Search for more papers by this authorJustin M. Wei MD
Department of Otolaryngology–Head and Neck Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii, USA
Search for more papers by this authorChristopher J. Gouveia MD
Department of Otolaryngology–Head and Neck Surgery, Kaiser Permanente - Santa Clara, Santa Clara, California, USA
Search for more papers by this authorSoroush Zaghi MD
UCLA Medical Center–Santa Monica, University of California–Los Angeles, Santa Monica, California, USA
Search for more papers by this authorScott B. Boyd DDS, PhD
Department of Oral and Maxillofacial Surgery, School of Medicine, Retired Faculty, Vanderbilt University, Nashville, Tennessee, USA
Search for more papers by this authorChristian Guilleminault MD
Sleep Medicine Division, Department of Psychiatry, Stanford Hospital and Clinics, Redwood City, California, USA
Search for more papers by this authorCorresponding 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 authorMichael W. Noller MD
Walter Reed National Military Medical Center, Bethesda, Maryland, USA
Search for more papers by this authorMichael Del Do MD
Department of Otolaryngology–Head and Neck Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii, USA
Search for more papers by this authorJustin M. Wei MD
Department of Otolaryngology–Head and Neck Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii, USA
Search for more papers by this authorChristopher J. Gouveia MD
Department of Otolaryngology–Head and Neck Surgery, Kaiser Permanente - Santa Clara, Santa Clara, California, USA
Search for more papers by this authorSoroush Zaghi MD
UCLA Medical Center–Santa Monica, University of California–Los Angeles, Santa Monica, California, USA
Search for more papers by this authorScott B. Boyd DDS, PhD
Department of Oral and Maxillofacial Surgery, School of Medicine, Retired Faculty, Vanderbilt University, Nashville, Tennessee, USA
Search for more papers by this authorChristian Guilleminault MD
Sleep Medicine Division, Department of Psychiatry, Stanford Hospital and Clinics, Redwood City, California, USA
Search for more papers by this authorAbstract
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.
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