School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Stanford Hospital and Clinics, Department of Psychiatry, Sleep Medicine Division, 450 Broadway, Redwood City, CA 94063, USA.
J Craniomaxillofac Surg. 2017 Dec;45(12):2035-2040. doi: 10.1016/j.jcms.2017.10.006. Epub 2017 Oct 13.
Patients with mandibular insufficiency can be predisposed to obstructive sleep apnea (OSA). The objective of this study was to systematically review the international literature for mandibular advancement surgeries (MAS) as treatment for adult OSA, and then to perform a meta-analysis.
Four authors searched five databases from the inception of each database through April 5, 2017. The PRISMA statement was followed.
972 studies were screened, 84 were downloaded, and 11 (57 patients) met criteria. In patients with mandibular insufficiency, MAS reduced apnea-hypopnea index (AHI) (50 patients) from 45.9 ± 24.7 to 6.2 ± 10.4 events/h (87% decrease). The lowest oxygen saturation (LSAT) (55 patients) increased from 71.9 ± 14.6% to 89.0 ± 11.0%. The AHI mean difference was -34.8 events/h [95% CI -43.9, -25.8]. The AHI standardized mean difference was -1.8 [95% CI -2.5, -1.2] (indicating a large magnitude of effect). Surgical cure was seen in 75% of those with >16 mm of mandibular advancement vs. 35% of those with <16 mm of advancement [Odds Ratio 5.5; 95% CI 1.06-28.4; Chi Square p = 0.035].
The current literature supports isolated mandibular advancement as an efficacious treatment modality for adult OSA in select patients with mandibular insufficiency.
下颌骨不足的患者易患阻塞性睡眠呼吸暂停（OSA）。本研究的目的是系统地回顾国际文献中关于下颌前伸术（MAS）治疗成人 OSA 的治疗效果，并进行荟萃分析。
四位作者从每个数据库的创建日期到 2017 年 4 月 5 日在五个数据库中进行了搜索。本研究遵循 PRISMA 声明。
共筛选出 972 项研究，下载了 84 项研究，其中 11 项（57 例患者）符合标准。在存在下颌骨不足的患者中，MAS 降低了呼吸暂停低通气指数（AHI）（50 例患者）从 45.9±24.7 降至 6.2±10.4 次/小时（降低 87%）。最低血氧饱和度（LSAT）（55 例患者）从 71.9±14.6%增加到 89.0±11.0%。AHI 的平均差值为-34.8 次/小时[95%置信区间（CI）-43.9，-25.8]。AHI 的标准化均数差值为-1.8[95% CI-2.5，-1.2]（表明效应幅度较大）。在有>16mm 下颌骨前伸的患者中，有 75%的患者手术治愈，而在有<16mm 下颌骨前伸的患者中，只有 35%的患者手术治愈[优势比 5.5；95%置信区间（CI）1.06-28.4；卡方检验 p=0.035]。
目前的文献支持孤立性下颌前伸术作为下颌骨不足的成人 OSA 的有效治疗方法，特别适用于特定的患者。
