Is Maxillomandibular Advancement Associated With Comorbidity Reduction in Patients With Obstructive Sleep Apnea?

This study investigated whether patients with documented obstructive sleep apnea (OSA) who have a decrease in apnea-hypopnea index (AHI) score and self-reported symptoms after maxillomandibular advancement (MMA) with genial tubercle advancement (GTA) also have a change in their medical comorbidity profile a minimum of 2 years postoperatively. Changes in the quantity of medical diagnoses, quantity of prescription medications, and average weight and body mass index (BMI) were assessed.

This is a retrospective cohort study of patients with a diagnosis of OSA (AHI score >5 on polysomnogram [PSG]) treated at the Massachusetts General Hospital (Boston, MA) with MMA and GTA from 2001 through 2015. Patients were identified through the oral and maxillofacial surgery 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 the authors' previous study (J Oral Maxillofac Surg 76:1999.e1, 2018). Two-tailed paired t tests were used for continuous variables and χ² or Fisher exact tests were used for categorical variables.

Forty-six patients (39 men, 7 women) met the inclusion criteria. Average weight (206.7 ± 42.4 lb preoperatively; 213.8 ± 41.7 lb postoperatively; P = .014) and average BMI (30.0 ± 5.7 kg/m² preoperatively; 30.9 ± 5.3 kg/m² postoperatively; P = .041) significantly increased in patients postoperatively. No meaningful changes in the number of medical diagnoses or number of prescription medications were noted. Stratification of patients by BMI showed significant increases in weight (188.6 ± 21.5 lb preoperatively; 200.1 ± 27.9 lb postoperatively; P = .0085) and BMI (27.1 ± 1.44 kg/m² preoperatively; 28.9 ± 3.52 kg/m² postoperatively; P = .013) only in "overweight" patients. No other parameters were found to be relevant.

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