title: Long-Term Effectiveness and Safety of Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea.
abstract: OBJECTIVE
  To determine the long-term clinical effectiveness and safety of maxillomandibular advancement (MMA) for the treatment of moderate to severe obstructive sleep apnea (OSA).
  
  
  METHODS
  A prospective two-center cohort study design was used to evaluate OSA patients who underwent MMA > 2 years ago. The primary outcome measure was the apnea-hypopnea index (AHI). Secondary outcome measures included blood pressure (BP), sleepiness (Epworth Sleepiness Scale [ESS]), and quality of life (Functional Outcomes of Sleep Questionnaire [FOSQ]).
  
  
  RESULTS
  30 adult patients (80% men, age 50.5 ± 9.6 years [mean ± SD]) participated in the study. The AHI decreased from a mean of 49 to 10.9 events/h (p < 0.0001) at the time of long-term evaluation (6.6 ± 2.8 years after MMA), with 46.7% of patients obtaining an AHI < 5 and 83.4% of patients attaining an AHI ≤ 15 events/h. The mean diastolic BP decreased from 83.7 to 79.0 mm Hg (p < 0.05). ESS decreased from a mean of 12.1 to 6.0 (p < 0.01). FOSQ increased from a mean of 12.6 to 17.3 (p < 0.05). Few long-term treatment-related adverse events occurred, which had minimal impact on quality of life (QOL).
  
  
  CONCLUSIONS
  MMA is a clinically effective and safe long-term treatment for most patients with moderate-to-severe OSA as demonstrated by significant decreases in AHI, diastolic BP, and subjective sleepiness, with concomitant significant improvements in QOL. The results of this small cohort study suggest that MMA should be considered as the alternative treatment of choice for patients with severe OSA who cannot fully adhere to CPAP therapy.
authors.affiliation: Department of Neurology, Sleep Disorders Division, Vanderbilt University School of Medicine, Nashville, TN.|Department of Oral and Maxillofacial Surgery, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Boyd
authors.affiliation: Department of Neurology, Sleep Disorders Division, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Walters
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Peter
authors.initials: P
authors.lastname: Waite
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Harding
authors.affiliation: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Yanna
authors.initials: Y
authors.lastname: Song
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000009:adverse effects / Q000379:methods*; D008437:Maxilla / Q000601:surgery; D008875:Middle Aged; D061214:Patient Safety; D017286:Polysomnography / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000601:surgery*; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome
keywords: apnea-hypopnea index; cohort study; daytime sleepiness; maxillomandibular advancement; obstructive sleep apnea; quality of life; safety; treatment outcome