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MMA is a highly effective and safe treatment for OSA, which predictably leads to significant improvements in sleepiness, QOL, sleep-disordered breathing, and neurocognitive performance, as well as a reduction in cardiovascular risk (blood pressure).

Purpose To directly compare the clinical effectiveness of maxillomandibular advancement (MMA) and uvulopalatopharyngoplasty (UPPP)—performed alone and in combination—for the treatment of moderate to severe obstructive sleep apnea (OSA). Methods The investigators designed and implemented a retrospective cohort study composed of subjects with moderate to severe OSA (baseline AHI >15). The predictor variable was operative treatment and included: MMA, UPPP, and MMA followed by UPPP (UPPP/MMA). The primary outcome variable was the apnea-hypopnea index (AHI) measured preoperatively and 3–6 months postoperatively. Other variables were grouped into the following categories: demographic, respiratory and sleep parameters. Descriptive and bivariate statistics were computed. Results The sample was composed of 106 subjects grouped as follows: MMA (n=37), UPPP (n=34), and UPPP/MMA (n=35) for treatment of OSA. There were no significant differences between the three groups for the study variables at baseline, except for AHI. Surgical treatment resulted in a significant decrease in AHI in each group: MMA (baseline AHI, 56.3 ± 22.6 vs. AHI after MMA, 11.4 ± 9.8; P <0.0001), UPPP/MMA (baseline AHI, 55.7 ± 49.2 vs. AHI after UPPP/MMA, 11.6 ± 10.7; P <0.0001) and UPPP (baseline AHI, 41.8 ± 28.0 vs. AHI after UPPP, 30.1 ± 27.5; P = 0.0057). After adjusting for differences in baseline AHI, the estimated mean change in AHI was significantly larger for MMA compared to UPPP (MMA AHI, −40.5 vs. UPPP AHI, –19.4; P = <0.0001). UPPP/MMA was no more effective than MMA (P = 0.684). Conclusion The results of this study suggest that MMA should be the surgical treatment option of choice for most patients with moderate to severe OSA who are unable to adequately adhere to CPAP.

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Significant disease burden, as objectively measured by the Effective AHI, may still exist in many patients with severe OSA in whom PAP therapy is not utilized for the entire sleep period. The WP is a reasonably accurate device to measure the Effective AHI.