Stanford University Sleep Medicine Program, Stanford University School of Medicine, Stanford, CA, USA.
Sleep Med Rev. 2010 Oct;14(5):287-97. doi: 10.1016/j.smrv.2009.11.003. Epub 2010 Mar 2.
The reported efficacy of maxillomandibular advancement (MMA) for the treatment of obstructive sleep apnea (OSA) is uncertain. We performed a meta-analysis and systematic review to estimate the clinical efficacy and safety of MMA in treating OSA. We searched Medline and bibliographies of retrieved articles, with no language restriction. We used meta-analytic methods to pool surgical outcomes. Fifty-three reports describing 22 unique patient populations (627 adults with OSA) met inclusion criteria. Additionally, 27 reports provided individual data on 320 OSA subjects. The mean apnea-hypopnea index (AHI) decreased from 63.9/h to 9.5/h (p<0.001) following surgery. Using a random-effects model, the pooled surgical success and cure (AHI <5) rates were 86.0% and 43.2%, respectively. Younger age, lower preoperative weight and AHI, and greater degree of maxillary advancement were predictive of increased surgical success. The major and minor complication rates were 1.0% and 3.1%, respectively. No postoperative deaths were reported. Most subjects reported satisfaction after MMA with improvements in quality of life measures and most OSA symptomatology. We conclude that MMA is a safe and highly effective treatment for OSA.
经口下颌前导术（MMA）治疗阻塞性睡眠呼吸暂停（OSA）的疗效报道并不确定。我们进行了荟萃分析和系统评价，以评估 MMA 治疗 OSA 的临床疗效和安全性。我们检索了 Medline 数据库和检索到的文章的参考文献，无语言限制。我们使用荟萃分析方法汇总了手术结果。有 53 份报告描述了 22 个独特的患者群体（627 名患有 OSA 的成年人）符合纳入标准。此外，有 27 份报告提供了 320 名 OSA 患者的个体数据。手术治疗后，呼吸暂停低通气指数（AHI）从 63.9/h 降至 9.5/h（p<0.001）。使用随机效应模型，汇总的手术成功率和治愈率（AHI<5）分别为 86.0%和 43.2%。年龄较小、术前体重和 AHI 较低、上颌骨前突程度较大是手术成功率提高的预测因素。主要和次要并发症发生率分别为 1.0%和 3.1%。术后无死亡报告。大多数患者报告 MMA 后生活质量得到改善，大多数 OSA 症状得到缓解。我们得出结论，MMA 是 OSA 的一种安全且非常有效的治疗方法。
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