title: [Oral appliances or maxillomandibular advancement osteotomy for severe obstructive sleep apnoea in patients refusing CPAP].
abstract: OBJECTIVE
  The management of patients with severe obstructive sleep apnea syndrome (OSAS) refusing or not tolerating continuous positive pressure ventilation (CPAP) remains problematic. We evaluated the effectiveness of oral appliances and of maxillomandibular advancement osteotomy.
  
  
  METHODS
  One hundred and two patients with severe OSAS were included between 2001 and 2006. Maxillo-mandibular advancement osteotomy was proposed to patients less than 60 years of age, non obese and without comorbidities. The other patients were treated with oral appliances. All patients underwent polysomnography at 3 months.
  
  
  RESULTS
  Group A: 25 patients with mean apnea-hypopnea index (AHI) at 45/h were treated by maxillo-mandibular advancement. Three months after the surgery, AHI had decreased from 45 to 7. The success rate was 89% when AHI was less than 15/h and 74% when AHI was less than 10/h. Sixteen patients performed a polysomnography one year after surgery with similar results. There were no major postoperative complications. Group B: 77 patients with a mean AHI at 41/h were treated with oral appliances. Only 23 patients underwent polysomnography at 3 months. The mean AHI had decreased from 41/h to 22/h. The success rate was 56% when AHI was less than 15/h and 30% when AHI was less than 10/h.
  
  
  CONCLUSIONS
  We are confronted with an increasing number of severe OSAS patients with CPAP failure or intolerance. Surgery for maxillo-mandibular advancement is an effective alternative. However, it is not always indicated or accepted by the patient. So an oral appliance remains a useful therapeutic option despite its moderate success rate.
authors.affiliation: Service de Chirurgie Maxillo-Faciale, CHU Toulouse Purpan, 1, place du Dr.-Baylac, 31059 Toulouse cedex 9, France. jalbert.f@chu-toulouse.fr
authors.forename: F
authors.initials: F
authors.lastname: Jalbert
authors.forename: L
authors.initials: L
authors.lastname: Lacassagne
authors.forename: J
authors.initials: J
authors.lastname: Bessard
authors.forename: C
authors.initials: C
authors.lastname: Dekeister
authors.forename: J-R
authors.initials: JR
authors.lastname: Paoli
authors.forename: M
authors.initials: M
authors.lastname: Tiberge
mesh_terms: D000328:Adult; D000368:Aged; D045422:Continuous Positive Airway Pressure / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation* / Q000379:methods*; D008341:Mandibular Prosthesis / Q000706:statistics & numerical data; D008437:Maxilla / Q000601:surgery*; D008447:Maxillofacial Prosthesis / Q000706:statistics & numerical data; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D057240:Patient Preference; D017286:Polysomnography; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome; D016312:Treatment Refusal