title: [Comparative effectiveness of maxillomandibular advancement surgery versus mandibular advancement device for patients with moderate or severe obstructive sleep area].
abstract: BACKGROUND
  Currently, positive airway pressure is the gold standard treatment of obstructive sleep apnea (OSA). Unfortunely, adherence rates are poor. Alternative therapies are mandibular advancement device (MAD) and maxillomandibular advancement (MMA).
  
  
  METHODS
  This retrospective study compared both treatment effectiveness on patients with moderate and severe OSA from January 2005 to September 2012, and carried out predictive factor of effectiveness. We defined therapeutic success as an apnea hypopnea index (AHI) less than 15 per hour and at least a 50% reduction of the initial index. The difference in effectiveness has been studied using regression logistic adjusted on MAD versus MMA propensity score.
  
  
  RESULTS
  This study included 198 patients. 37 were treated by MMA, and 161 with MAD. MMA treatment was significantly more efficient than MAD treatment with an odds ratio of 3.22; CI95% 1.31Γ7.82 (p = 0.011). Younger age and lower initial AHI were predictive of increased success. There was no significant interaction between the treatment and morphologic patient factors.
  
  
  CONCLUSIONS
  In our sample of patients, MMA surgery was significantly more efficient than MAD treatment for the patients with moderate or severe OSA. No morphologic characteristic was identified to determine which patients would benefit most from MAD versus MMA surgery.
authors.affiliation: Département Universitaire de Chirurgie Maxillo-Faciale et Stomatologie, Hôpital Roger Salengro CHU Lille, rue Émile Laine, 59037 Lille, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Garreau
authors.affiliation: Département Universitaire de Chirurgie Maxillo-Faciale et Stomatologie, Hôpital Roger Salengro CHU Lille, rue Émile Laine, 59037 Lille, France - Unité INSERM U1008, Médicaments et Biomatériaux à Libération Contrôlée, Faculté des Sciences Pharmaceutiques et Biologiques 3 rue du Professeur Laguesse, 59000 Lille, France - Association Internationale de Médecine Orale et Maxillo-Faciale, 7 bis rue de la Créativité, 59650 Villeneuve-d'Ascq, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wojcik
authors.affiliation: UMRS - 1018 INSERM Centre de Recherche en Épidémiologie et Santé des Populations, Hôpital Paul Brousse, 12 av. Paul Vaillant Couturier, 94800 Villejuif, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Bouscaillou
authors.affiliation: Département Universitaire de Chirurgie Maxillo-Faciale et Stomatologie, Hôpital Roger Salengro CHU Lille, rue Émile Laine, 59037 Lille, France - Unité INSERM U1008, Médicaments et Biomatériaux à Libération Contrôlée, Faculté des Sciences Pharmaceutiques et Biologiques 3 rue du Professeur Laguesse, 59000 Lille, France - Association Internationale de Médecine Orale et Maxillo-Faciale, 7 bis rue de la Créativité, 59650 Villeneuve-d'Ascq, France - Université Lille Nord de France, UDSL, 1 rue Lefèvre, 59000 Lille, France.
authors.forename: Joël
authors.initials: J
authors.lastname: Ferri
authors.affiliation: Département Universitaire de Chirurgie Maxillo-Faciale et Stomatologie, Hôpital Roger Salengro CHU Lille, rue Émile Laine, 59037 Lille, France - Unité INSERM U1008, Médicaments et Biomatériaux à Libération Contrôlée, Faculté des Sciences Pharmaceutiques et Biologiques 3 rue du Professeur Laguesse, 59000 Lille, France - Association Internationale de Médecine Orale et Maxillo-Faciale, 7 bis rue de la Créativité, 59650 Villeneuve-d'Ascq, France - Université Lille Nord de France, UDSL, 1 rue Lefèvre, 59000 Lille, France.
authors.forename: Gwenaël
authors.initials: G
authors.lastname: Raoul
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D002508:Cephalometry / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D063172:Genioplasty / Q000379:methods; D005927:Glossectomy / Q000379:methods; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D019186:Mandibular Advancement / Q000295:instrumentation*; D008437:Maxilla / Q000601:surgery*; D008875:Middle Aged; D016382:Orthodontic Appliance Design; D056948:Orthognathic Surgical Procedures / Q000379:methods*; D019340:Osteotomy, Le Fort / Q000379:methods; D059229:Osteotomy, Sagittal Split Ramus / Q000379:methods; D017286:Polysomnography / Q000379:methods; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000145:classification / Q000601:surgery* / Q000628:therapy; D012894:Sleep Stages; D016896:Treatment Outcome; D055815:Young Adult