Racial variations in maxillomandibular advancement for obstructive sleep apnea: a systematic review and meta-analysis

We aimed to explore alterations in polysomnographic, cephalometric, and subjective outcomes amongst different ethnic/racial groups after MMA for OSA.

A meta-analysis was performed according to PRISMA reporting guidelines. The COCHRANE Library, CINAHL, PubMed, and Scopus were searched from inception to August 8, 2023. Each measure was weighted according to the number of patients affected. Heterogeneity among studies was assessed using χ2 and I2 statistics with fixed effects (I² < 50%) and random effects (I² ≥ 50%).

Twenty studies with a total of 469 patients (n = 257 Caucasians, n = 204 Asians, n = 8 Latinos) with a mean patient age of 40.0 years (range: 18-67; 95% CI: 38.0, 42.1). The mean difference for Caucasians were AHI: -39.6 (95% CI: -55.0, -24.1; p <.001), LSAT: 7.5 (95% CI: 5.7, 9.3; p <.0001), and ESS: -4.5 (95% CI: -5.6, -3.4; p <.0001). The mean difference for Asians were AHI: -42.7 (95% CI -49.3, -36.0; p <.0001), LSAT: 13.8 (95% CI: 10.0, 17.4; p <.0001), and ESS: -6.7 (95% CI: -9.9, -3.5; p <.0001). The mean difference for Latinos were AHI: -21.2 (95 CI%: -37.7, -4.6; p =.01), and ESS: -2.0 (-7.9, 3.9; p =.50). Greater reduction of AHI was seen in Asians vs. Caucasians and Asians vs. Latinos. Lastly, the reduction of ESS was significantly better for Asians vs. Caucasians.

The study highlights significant variations in MMA outcomes among different ethnic/racial groups. Asians tend to have more severe OSA preoperatively and experience greater postoperative improvements in AHI, LSAT, and ESS compared to Caucasians.