title: Effects of maxillomandibular advancement on systemic blood pressure in patients with obstructive sleep apnoea.
abstract: Obstructive sleep apnoea (OSA) is associated with resistant hypertension. We investigated to what extent maxillomandibular advancement affected a patient's blood pressure postoperatively. We retrospectively analysed consecutive patients who had Bimaxillary advancement for OSA at our hospital following referral from the local sleep clinic. We collected relevant data on clinical characteristics and explored the changes in systolic and diastolic blood pressures, as well as mean arterial pressure (MAP) preoperatively, with those taken 6 months following surgery. We identified 51 patients with a mean (SD) age of 44 (8) years and a mean (SD) body mass index of 29 (3.4). Preoperative and postoperative data on blood pressure were available for analysis in 45. The mean (SD) systolic blood pressure was significantly reduced in our sample following surgery (from 131(12.6) to 127 (12.5)mmHg, p<0.001). The mean (SD) reduction in postoperative MAP values in the overall group, approached statistical significance (recorded MAP 96.6(10) to 93.1(8)mmHg, p=0.06). In a subgroup of 10 patients who had established hypertension the reduction in values postoperatively (mean reduction: systolic blood pressure 6 mmHg, diastolic blood pressure 10 mmHg, mean arterial pressure 9 mmHg) was greater than that observed in the overall group. Our results have shown an improvement in systemic blood pressure after maxillomandibular advancement for OSA, particularly in those with established hypertension. The data suggest that in addition to being a highly effective treatment for OSA, this surgery may more effectively lower systemic blood pressure than other treatment modalities.
authors.affiliation: Department of Maxillofacial Surgery, Leicester Royal Infirmary, Leicester LE1 5WW, UK. Electronic address: drshafiqislam@hotmail.co.uk.
authors.forename: Shofiq
authors.initials: S
authors.lastname: Islam
authors.affiliation: Department of Respiratory Medicine, Salisbury District Hospital, Wiltshire, Salisbury SP2 8BJ, UK.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Taylor
authors.affiliation: Department of Maxillofacial Surgery, Leicester Royal Infirmary, Leicester LE1 5WW, UK.
authors.forename: Ian W
authors.initials: IW
authors.lastname: Ormiston
mesh_terms: D000328:Adult; D062186:Arterial Pressure / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology*; D015992:Body Mass Index; D015331:Cohort Studies; D003971:Diastole / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D008297:Male; D019186:Mandibular Advancement / Q000379:methods*; D008437:Maxilla / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000601:surgery*; D013599:Systole / Q000502:physiology; D016896:Treatment Outcome
keywords: Hypertension; Maxillomandibular advancement surgery; Modification; Obstructive sleep apnoea; Orthognathic surgery; Systemic blood pressure