Objective and subjective long term outcome of maxillomandibular advancement in obstructive sleep apnea

Study objectives: To evaluate the objective and subjective long-term outcome of maxillomandibular advancement (MMA) in Far-East Asian patients with moderate to severe obstructive sleep apnea (OSA). Methods: This is a long-term follow-up study to evaluate the treatment outcome of MMA in OSA patients by objective polysomnography (PSG) and subjective questionnaires (Pittsburgh Sleep Quality Index-PSQI, Insomnia Severity Index-ISI, Beck Anxiety Inventory-BAI, Beck Depression Inventory-BDI, Epworth Sleepiness scale-ESS, and Short Form-36 Quality of Life-SF-36). Evaluation was done before surgery and we followed these patients one and two years after surgery. We also assessed the neurocognitive function by Continuous performance test (CPT) and Wisconsin Card Sorting Test (WCST) before and after MMA. Results: A total of 82 patients with OSA (female = 19) were enrolled and 53 participants (75.7% men, age 35.66 +/- 11.66 years [mean +/- SD], BMI = 24.80 +/- 3.29) completed the two-year follow-up. The apneahypopnea index (AHI) decreased from a mean of 34.78 +/- 26.01 to 3.61 +/- 2.79 and 7.43 +/- 6.70 events/hour (p = 0.007) at the first and second year evaluation. There was significant improvement in PSG (especially respiratory profile), questionnaires (PSQI and ISI total score), and neurocognitive testing (attention and executive function) after MMA. Meanwhile, no major complication such as avascular necrosis of bonny segments, facial nerve injury, blindness or compromise of airway was found after surgery. Conclusions: MMA is a clinically effective treatment for patients with moderate-to-severe OSA as demonstrated by significant long-term decrease in AHI and improvement in neurocognitive testing. (C) 2020 Elsevier B.V. All rights reserved.