Long-term quality of life outcomes of maxillomandibular advancement osteotomy in patients with obstructive sleep apnoea syndrome

Abstract

We evaluated the long-term impact of maxillomandibular advancement (MMA) surgery on the apneahypopnea index (AHI) and quality of life (QoL) in patients with obstructive sleep apnea syndrome (OSAS). The medical files of 12 OSAS patients undergoing MMA by one surgeon between 1995 and 1999 were retrospectively reviewed. Patients received a clinical assessment, polysomnography and QoL questionnaires as part of routine care preoperatively (n=12), within two year postoperatively (n=12), and again in 2016 (n=9). Successful surgical outcome was defined as an AHI decrease of > 50% and < 20/h. Of the 66.6% (8/12) of patients who were initially cured, 66.6% (4/6) remained stable at a median follow-up of 19 years. Only the two patients with the highest AHI showed abnormal Epworth Sleepiness scores. After convalescence, most patients reported stable symptomatic improvement. Esthetic changes were found acceptable and all but one patient stated that they would undergo the surgery again.We conclude that MMA is a safe and effective procedure. Ageing and weight gain might counterbalance the positive effects of surgery in the long run. We, therefore, suggest that five-annual re-evaluation should be scheduled since spontaneous AHI increase over time does not seem to be reflected by symptomatic changes.

Patient-Reported Outcomes of Maxillomandibular Surgery for Obstructive Sleep Apnea Treatment: A Scoping Review

“…Regarding the instruments, five articles used a single questionnaire [ 27 , 29 , 30 , 36 , 37 ], while eleven employed multiple questionnaires, with the most extensive one using six [ 38 ]. The most commonly referred instruments were the Epworth Sleepiness Scale (nine studies) [ 27 , 28 , 31 , 34 , 35 , 37 , 38 , 39 , 40 , 41 ], SF-36 (four studies) [ 32 , 38 , 39 , 42 ], Functional Outcomes of Sleep (three studies) [ 31 , 39 , 41 ], Ottawa Sleep Apnea (two studies) [ 36 , 39 ], and Rustemever’s method (two studies) [ 32 , 33 ]. The most evaluated outcomes were sleep quality, daytime function, facial aesthetics, dental function and emotional health.…”

Alternative Approaches to Adenotonsillectomy and Continuous Positive Airway Pressure (CPAP) for the Management of Pediatric Obstructive Sleep Apnea (OSA): A Review

“…In the case of one cohort by Vigneron et al, the AHI increased to 25.5 at approximately 13 years after MMA, which would qualify as surgical failure by typical definitions [ 57 , 58 ]. In a cohort of 9 patients from an initial cohort of 12 followed for a median of 19 years, successfully treated patients showed no significant symptoms of sleepiness or change in quality of life measures covering headaches, concentration, insomnia, or snoring despite two patients relapsing to prior to procedure AHI values [ 59 ].…”

Quality of Life in Obstructive Sleep Apnea Patients Who Underwent Maxillomandibular Advancement Surgery

“…Several studies have demonstrated its effectiveness, safety, and success in reducing daytime sleepiness and AHI in the short and long term 2,6,9–14. However, few studies have addressed the impact of MMA on the health-related quality of life (HRQOL) of patients with OSA 6,13–16…”

“…2,6,[9][10][11][12][13][14] However, few studies have addressed the impact of MMA on the health-related quality of life (HRQOL) of patients with OSA. 6,[13][14][15][16] The assessment of HRQOL through patient-reported outcome measures has recently contributed to improving care strategies. This method considers the perception of the physical and psychosocial well-being of people who experience problems in their daily lives arising from health interventions.…”