Surgery vs ventilation in adult severe obstructive sleep apnea syndrome.
OBJECTIVE
Management of severe obstructive sleep apnea-hypopnea syndrome (OSAHS) is challenging and needs multidisciplinary cooperation. Ventilation is considered the gold standard of treatment in severe OSAHS. The aim of the study was to compare the therapeutical efficacy of a type of surgery (maxillomandibular advancement [MMA]) vs a ventilatory treatment modality (autotitrating positive airway pressure [APAP]).


METHODS
At the ENT Department of Forlì Hospital (University of Pavia), in strict cooperation with the Sleep Lab of the University of Bologna, a prospective randomized controlled trial was designed and performed. After fully informing them, 50 consecutive patients who have severe OSAHS were enrolled and randomized into a conservative (APAP) or surgical (MMA) section. Demographic, biometric, polysomnogram (PSG) and Epworth Sleepiness Scale profiles of the 2 groups were statistically not significantly different.


RESULTS
One year after surgery or continuous APAP treatment, both groups showed a remarkable improvement of mean Apnea-Hypopnea Index (AHI) and Epworth Sleepiness Scale levels; the degree of improvement was not statistically different.


CONCLUSIONS
Given the relatively small sample of subjects studied and the relatively brief follow-up, MMA proved to be a valuable alternative therapeutical tool in our adult and severe OSAHS patient group, with a success rate not inferior to APAP.
Vicini
Claudio
C
ENT & Oral Surgery Unit, Ospedale Morgagni Pietrantoni, Forlì, Italy.
Dallan
Iacopo
I
Campanini
Aldo
A
De Vito
Andrea
A
Barbanti
Francesca
F
Giorgiomarrano
Gianluca
G
Bosi
Marcello
M
Plazzi
Giuseppe
G
Provini
Federica
F
Lugaresi
Elio
E
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006801:Humans; D019248:Jaw Fixation Techniques; D008297:Male; D019186:Mandibular Advancement; D008875:Middle Aged; D017060:Patient Satisfaction; D017286:Polysomnography; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome