MINNEAPOLIS – Maxillomandibular advancement may be a reasonable option for patients who have severe sleep apnea and are unable to tolerate continuous positive airway pressure therapy, according to a study by the Department of Veterans Affairs.
In maxillomandibular advancement (MMA), the upper and lower jaws are moved forward to optimize the airway and minimize soft-tissue blockages. Dr. Vincent Mysliwiec and his colleagues in the Critical Care Medicine and Sleep Medicine Service at Madigan Healthcare System, Joint Base Lewis-McChord in Tacoma, Wash., evaluated the outcomes of the surgery in an active-duty population.
"Obstructive sleep apnea is an increasingly common diagnosis in soldiers, and those soldiers with more severe cases are not deployable without going through an extensive waiver process," Dr. Mysliwiec said at the annual meeting of the Associated Professional Sleep Societies. "We wanted to assess whether [MMA] represents a surgical cure that can potentially remove the requirement for CPAP in these individuals and, in so doing, increase the number of soldiers who are fully deployable."
The researchers reviewed all of the MMA procedures performed for obstructive sleep apnea at their institution in 2006-2009 and identified 37 soldiers who had severe disease – defined as an apnea-hypopnea index (AHI) of more than 30 events/hr – and underwent the surgery as well as pre- and postoperative polysomnography. The primary study outcomes were comparisons of the pre- and postoperative AHI and minimum nocturnal oxyhemoglobin saturation. Surgical cure was defined as an AHI reduction of at least 50%, compared with preoperative AHI, and a postoperative AHI of less than 15.
The mean body mass index of the study cohort was 29 kg/m2, and the mean preoperative AHI was 50.5, Dr. Mysliwiec reported. Following the procedure, "the mean postoperative [AHI] dropped significantly to 13.8," he said. "Twenty-two of the soldiers – nearly 60% of the group – reduced their [AHI] by at least half, which met the criteria for surgical cure." Further, he said, 16 of the soldiers had a postoperative AHI of less than 5, "meaning they had no residual disease at all following the procedure." One study patient did not experience a clinically significant reduction in AHI following the surgery. The mean minimum nocturnal oxyhemoglobin saturation increased postoperatively from 85% to 86%, a nonsignificant change (P = .21; standard deviation for both measures, 7%).
"Maxillomandibular advancement significantly reduced the severity of sleep apnea for our patients and improved the quality of their sleep," Dr. Mysliwiec said. "These findings could improve the standard of care for civilians and active-duty service members with severe obstructive sleep apnea who can’t tolerate CPAP or have failed other soft-tissue procedures."
Dr. Mysliwiec reported having no financial conflicts of interest.