Open AccessLong‐term Results for Maxillomandibular Advancement to Treat Obstructive Sleep Apnea: A Meta‐analysis
Author(s) -
Camacho Macario,
Noller Michael W.,
Del Do Michael,
Wei Justin M.,
Gouveia Christopher J.,
Zaghi Soroush,
Boyd Scott B.,
Guilleminault Christian
Publication year - 2019
Publication title -
otolaryngology–head and neck surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.232
H-Index - 121
eISSN - 1097-6817
pISSN - 0194-5998
DOI - 10.1177/0194599818815158
Subject(s) - medicine , obstructive sleep apnea , cochrane library , apnea , meta analysis , physical therapy , anesthesia
Objective To examine outcomes in the intermediate term (1 to <4 years), long term (4 to <8 years), and very long term (≥8 years) for maxillomandibular advancement (MMA) as treatment for obstructive sleep apnea (OSA). Data Sources The Cochrane Library, Google Scholar, Embase, Cumulative Index to Nursing and Allied Health, and PubMed/MEDLINE. Review Methods Three authors systematically reviewed the international literature through July 26, 2018. Results A total of 445 studies were screened, and 6 met criteria (120 patients). Thirty‐one patients showed a reduction in apnea‐hypopnea index (AHI) from a mean 48.3 events/h (95% CI, 42.1‐54.5) pre‐MMA to 8.4 (95% CI 5.6, 11.2) in the intermediate term. Fifty‐four patients showed a reduction in AHI from a mean 65.8 events/h (95% CI, 58.8‐72.8) pre‐MMA to 7.7 (95% CI 5.9, 9.5) in the long term. Thirty‐five showed a reduction in AHI from a mean 53.2 events/h (95% CI 45, 61.4) pre‐MMA to 23.1 (95% CI 16.3, 29.9) in the very long term. Improvement in sleepiness was maintained at all follow‐up periods. Lowest oxygen saturation improvement was maintained in the long term. Conclusion The current international literature shows that patients with OSA who were treated with MMA maintained improvements in AHI, sleepiness, and lowest oxygen saturation in the long term; however, the mean AHI increased to moderate OSA in the very long term. Definitive generalizations cannot be made, and additional research providing individual patient data for the intermediate term, long term, and very long term is needed.