Goodday Reginald H, Bourque Susan E, Edwards Pember B
Professor, Department of Oral and Maxillofacial Sciences, Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, Canada.
Private practice, Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, Canada.
J Oral Maxillofac Surg. 2016 Mar;74(3):583-9. doi: 10.1016/j.joms.2015.07.016. Epub 2015 Jul 26.
It is important for patients and treating clinicians to know whether maxillomandibular advancement (MMA) surgery is effective when treating patients with obstructive sleep apnea syndrome (OSAS) and an extremely high apnea-hypopnea index (AHI) score. The purpose of this study was to evaluate objective and subjective treatment outcomes after MMA surgery for the treatment of OSAS in patients with a preoperative AHI score higher than 100.
This retrospective study included all patients who underwent MMA surgery for OSAS by members of the Department of Oral and Maxillofacial Surgery, QEII Health Science Centre (Halifax, Nova Scotia, Canada) from November 1996 through February 2014. Objective data were available in the form of polysomnographs (PSGs) obtained before and a minimum of 6 months after surgery. Patients completed a self-administered questionnaire before and after surgery regarding snoring, witnessed apneas, continuous positive airway pressure (CPAP) use, daytime somnolence, and overall satisfaction.
Two hundred sixty-five patients had MMA surgery, of which 13 had pre- and postoperative PSGs. PSGs showed a mean preoperative AHI score of 117.9 and a mean postsurgical AHI score of 16.1 (P < .001). Pre- and postoperative questionnaires were available for 9 patients. After surgery, 7 patients denied having any daytime sleepiness and 2 patients reported minimal daytime sleepiness. The mean preoperative Epworth Sleepiness Scale score was 12.9 (standard deviation [SD], 5.5), whereas the postoperative mean score was 5.0 (SD, 4.1; P = .004). Before surgery, all 9 patients reported loud snoring and 8 reported witnessed apneas. After surgery, 2 patients reported minimal snoring and only 1 patient continued to have witnessed apneas. Six patients used CPAP preoperatively and only 1 patient continued to use CPAP after surgery.
The results of this study suggest that MMA surgery for treatment of extremely severe OSA can be a highly successful 1-stage surgery, which eliminates the use of CPAP, improves subjective outcomes, and considerably decreases the AHI score.
对于患者和治疗临床医生而言，了解下颌骨前移（MMA）手术在治疗阻塞性睡眠呼吸暂停综合征（OSAS）且呼吸暂停低通气指数（AHI）得分极高的患者时是否有效至关重要。本研究的目的是评估术前AHI得分高于100的患者接受MMA手术后的客观和主观治疗效果。
这项回顾性研究纳入了1996年11月至2014年2月期间在加拿大新斯科舍省哈利法克斯市QEII健康科学中心口腔颌面外科成员处接受MMA手术治疗OSAS的所有患者。客观数据以术前及术后至少6个月获得的多导睡眠图（PSG）形式提供。患者在手术前后完成了一份关于打鼾、目击性呼吸暂停、持续气道正压通气（CPAP）使用、日间嗜睡和总体满意度的自我管理问卷。
265例患者接受了MMA手术，其中13例有术前和术后的PSG。PSG显示术前AHI平均得分为117.9，术后AHI平均得分为16.1（P <.001）。9例患者有术前和术后问卷。术后，7例患者否认有任何日间嗜睡，2例患者报告有轻微日间嗜睡。术前Epworth嗜睡量表平均得分为12.9（标准差[SD]，5.5），而术后平均得分为5.0（SD，4.1；P =.004）。术前，所有9例患者均报告有大声打鼾，8例报告有目击性呼吸暂停。术后，2例患者报告有轻微打鼾，只有1例患者仍有目击性呼吸暂停。6例患者术前使用CPAP，术后只有1例患者继续使用CPAP。
本研究结果表明，MMA手术治疗极重度OSA可以是一种非常成功的一期手术，可消除CPAP的使用，改善主观效果，并显著降低AHI得分。
