Session: Pediatrics and OSA Track: Hot-off-the-Press and Abstract Session
GP2b - Retrospective Analysis of the Polysomnographic and Airway Changes in Obstructive Sleep Apnea (OSA) Subjects Who Underwent Maxillomandibular Advancement (MMA) Surgery
Resident Michigan Medicine Rochester Hills, Michigan
Abstract: Maxillomandibular (MMA) advancement leads to significant but heterogenous outcomes in the treatment of Obstructive sleep apnea (OSA). The aim of this study was to evaluate the relationship between skeletal and airway changes with polysomnographic outcomes after MMA surgery.
This is a retrospective analysis of 34 subjects (30 males) with OSA who underwent MMA surgery and had pre-operative and post-operative polysomnograms and CBCT scans. Predictor variables included age, pre-op AHI, BMI (BMI pre and BMI change), skeletal and airway changes. Our primary outcome variable was the change in AHI. Exploratory variables included oxygen saturation nadir, supine non-REM AHI, and achieving surgical success (defined as AHI < 15).
A correlation matrix though of all the outcomes and unadjusted predictors was performed using the Pearson correlation coefficient. Multivariable regression analysis was used to assess the effect of predictors on outcomes when adjusting for pre-op AHI, age, BMI and skeletal/airway variables with statistically significance set as a p-value < 0.05.
The study included 34 subjects (30 males) with obstructive sleep apnea (OSA) who underwent maxillomandibular advancement (MMA) surgery. The mean advancement was 8.4±3.0 mm at the maxillary central incisor, 6.3±2.9 mm at A-point, and 11.3±4.1 mm at B-point. The mean age was 47.4±13.0 years, the average pre-op BMI and postop BMI were 31.4 and 29.3 Kg/m2 respectively, and the average pre-op and post-op AHI were 48.3±22.8 and 14.3±12.8 events/hour. A mean AHI reduction of 32.8 (65%) events/hour was realized. Furthermore, in the group with surgical success, the AHI changed by 82.7%. A correlation analysis shows that pre-op AHI was strongly correlated with the change in AHI (-0.82, P< 0.0001) and supine NREM AHI (-0.50, P=0.011). Also, pre-op BMI and change in BMI were moderately correlated with the change in AHI (-0.34, P< 0.05 and 0.48, P=0.0044). A moderate association was seen between the SNA change (-0.40, P=0.02) and A-NPerp change (-0.33, P=0.062) relative to change in AHI. When adjusting for the age, pre-op BMI and skeletal/airway as covariates, multivariable model analysis demonstrated higher pre-op AHI is statistically significantly associated with greater AHI change (p value < 0.0001). The change at A-point (A-NPerp) was also inversely associated with supine NREM AHI change (-0.80, p=0.036). Also, lower pre-op (42.8, p= 0.05) AHI was statistically significantly associated with surgical success. Amongst patients with surgical success, pre-operative mandibular length (pre-Go-Pog) is shorter compared to those with surgical failure (69.6 vs. 73.9, p=0.04).
Higher pre-operative AHI values predicted a larger reduction in AHI with MMA surgery. However, individuals with more severe OSA pre-operatively (higher AHI) are less likely to achieve an AHI < 15 events/hour after surgery. Lower pre-BMI and sustained weight loss after surgery leads to greater AHI reduction, as does the amount of skeletal maxillary advancement. In the treatment of OSA, the magnitude of most skeletal and airway changes, as well as age, did not help predict response to surgery based on reductions in AHI or surgical success.
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2. Zaghi S, Holty JE, Certal V et al. Maxillomandibular advancement for treatment of OSA. A Meta-analysis. JAMA Otolaryngol Head Neck Surg. 2016; 142(1);58-66.