title: Maxillomandibular advancement and tracheostomy for morbidly obese obstructive sleep apnea: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The objective of this study is to systematically review polysomnography data and sleepiness in morbidly obese (body mass index [BMI] ≥40 kg/m(2)) patients with obstructive sleep apnea (OSA) treated with either a maxillomandibular advancement (MMA) or a tracheostomy and to evaluate the outcomes.
  
  
  METHODS
  MEDLINE, Scopus, Web of Science, and the Cochrane Library.
  
  
  METHODS
  A search was performed from inception through April 8, 2014, in each database.
  
  
  RESULTS
  Six maxillomandibular advancement studies (34 patients, age 42.42 ± 9.13 years, mean BMI 44.88 ± 4.28 kg/m(2)) and 6 tracheostomy studies (14 patients, age 52.21 ± 10.40 years, mean BMI 47.93 ± 7.55 kg/m(2)) reported individual patient data. The pre- and post-MMA means ± SDs for apnea-hypopnea indices were 86.18 ± 33.25/h and 9.16 ± 7.89/h (P < .00001), and lowest oxygen saturations were 66.58% ± 16.41% and 87.03% ± 5.90% (P < .00001), respectively. Sleepiness following MMA decreased in all 5 patients for whom it was reported. The pre- and posttracheostomy mean ± SD values for apnea indices were 64.43 ± 41.35/h and 1.73 ± 2.68/h (P = .0086), oxygen desaturation indices were 69.20 ± 26.10/h and 41.38 ± 36.28/h (P = .22), and lowest oxygen saturations were 55.17% ± 16.46% and 79.83% ± 4.36% (P = .011), respectively. Two studies reported outcomes for Epworth Sleepiness Scale for 5 patients, with mean ± SD values of 18.80 ± 4.02 before tracheostomy and 2.80 ± 2.77 after tracheostomy (P = .0034).
  
  
  CONCLUSIONS
  Data for MMA and tracheostomy as treatment for morbidly obese, adult OSA patients are significantly limited. We caution surgeons about drawing definitive conclusions from these limited studies; higher level studies are needed.
authors: Sleep Medicine Division, Stanford Hospital and Clinics, Redwood City, California, USA drcamachoent@yahoo.com.
authors: Macario
authors: M
authors: Camacho
authors: US Army, Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
authors: Jeffrey
authors: J
authors: Teixeira
authors: Department of Otorhinolaryngology, Hospital Bernardino Rivadavia, Buenos Aires, Argentina.
authors: Jose
authors: J
authors: Abdullatif
authors: US Army, Department of Otolaryngology-Head and Neck Surgery, Reynolds Army Community Hospital, Fort Sill, Oklahoma, USA.
authors: Jason L
authors: JL
authors: Acevedo
authors: Department of Otorhinolaryngology/Sleep Medicine Centre-Hospital CUF, Porto, Portugal CINTESIS-Centre for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal.
authors: Victor
authors: V
authors: Certal
authors: Department of Otolaryngology-Head and Neck Surgery, Sleep Surgery Division, Stanford University Medical Center, Stanford, California, USA.
authors: Robson
authors: R
authors: Capasso
authors: Department of Otolaryngology-Head and Neck Surgery, Sleep Surgery Division, Stanford Hospital and Clinics, Stanford, California, USA.
authors: Nelson B
authors: NB
authors: Powell
mesh_terms: D000328:Adult; D015897:Comorbidity; D006801:Humans; D019186:Mandibular Advancement / Q000379:methods; D008437:Maxilla / Q000601:surgery*; D009767:Obesity, Morbid / Q000453:epidemiology; D010027:Osteotomy / Q000379:methods; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology / Q000601:surgery*; D014139:Tracheostomy
keywords: maxillomandibular advancement; morbid obesity; obstructive sleep apnea; sleep apnea syndromes; tracheostomy