Is maxillomandibular advancement associated with comorbidity reduction in patients with obstructive sleep apnea?

Publication date: Available online 17 December 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Elaina Pullano, Richard Ngo, Zachary S. Peacock, Edward T. Lahey, Meredith August

Abstract

Purpose

In patients with documented obstructive sleep apnea (OSA) who experience reduction in AHI and self-reported symptoms after maxillomandibular advancement with genial tubercle advancement (MMA/GTA), is there also a change in the medical comorbidity profile a minimum of two years postoperatively? We are assessing for changes in: the quantity of medical diagnoses; the quantity of prescription medications; and the average weight and BMI.

Patients and Methods

This is a retrospective cohort study of patients with a diagnosis of OSA (AHI > 5 on polysomnogram (PSG)) treated at the Massachusetts General Hospital (MGH) with MMA/GTA between 2001-2015. Patients were identified through the OMS Patient Data Registry. Inclusion criteria were the availability of complete clinical records and requisite follow up time. The primary predictor variable was operative status (preoperative or postoperative). The primary outcome variables were comorbidities reported to be associated with OSA and identified in our previous paper. Two-tailed paired t-tests were used for continuous variables, and Chi-Square or Fisher's exact tests for categorical variables.

Results

Forty-six subjects (36 male, 7 female) met inclusion criteria. The average weight (206.7±42.4 lbs preoperatively, 213.8±41.7 lbs postoperatively; p=0.014) and average BMI (30.0±5.7 preoperatively, 30.9±5.3 postoperatively; p=0.041) significantly increased in subjects postoperatively. No significant changes in number of medical diagnoses or number of prescription medications were noted. Stratification of subjects by BMI revealed significant increase in weight (188.6±21.5 lbs preoperatively, 200.1±27.9 lbs postoperatively; p=0.0085) and BMI (27.1±1.44 preoperatively, 28.9±3.52 postoperatively; p=0.013) only among "Overweight" subjects. No other parameters were found to be significant.

Conclusion

Subjective improvement in OSA symptoms was reported in all patients and objective PSG improvement in 71% of those evaluated. However, no significant changes in comorbidity profile were found, suggesting that the medical conditions commonly observed with OSA are likely of multifocal etiology.

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