Ngo Richard, Pullano Elaina, Peacock Zachary S, Lahey Edward T, August Meredith
Resident, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
Student, Harvard School of Dental Medicine, Boston, MA.
J Oral Maxillofac Surg. 2018 Sep;76(9):1999.e1-1999.e8. doi: 10.1016/j.joms.2018.01.011. Epub 2018 Jan 31.
Obstructive sleep apnea (OSA) patients with retrognathia and measurable anatomic airway determinants may represent a subset of OSA patients and have distinct comorbidity profiles. Our aim was to compare the medical comorbidities of OSA patients managed surgically with maxillomandibular advancement with those of nonsurgical patients.
In this cross-sectional retrospective study, patients for both cohorts were identified through the Massachusetts General Hospital oral and maxillofacial surgery data registry and the Massachusetts General Hospital Research Patient Data Registry. The inclusion criteria consisted of clinical records documenting body mass index (BMI), apnea-hypopnea index, respiratory disturbance index, and/or oxygen nadir. The primary predictor variable was the treatment modality chosen: surgical (maxillomandibular advancement) or nonsurgical. Demographic information and OSA parameters were evaluated. The primary outcome variable was the number of documented comorbidities in each group. Two-sample t tests were used for continuous variables, whereas χ or Fisher exact tests were used for categorical variables.
The nonsurgical cohort consisted of 71 patients (67.6% men), and the surgical cohort consisted of 51 patients (84.3% men). Comparison of descriptive characteristics showed that the nonsurgical cohort had a higher average age (49 ± 9.4 years) than the surgical cohort (41 ± 10.7 years, P < .001). In addition, a higher average BMI was present in the nonsurgical group (42.3 ± 11.9 in nonsurgical group vs 29.7 ± 5.5 in surgical group, P < .001). Polysomnogram parameters were comparable with the exception of a higher Epworth Sleepiness Scale score in the surgical cohort (15.5 ± 5.30 in surgical group vs 9.90 ± 6.80 in nonsurgical group, P = .005). The nonsurgical cohort had a higher total number of comorbidities (7 ± 4 in nonsurgical group vs 4 ± 3 in surgical group, P < .001). Hypertension, cardiovascular disease, hyperlipidemia, pulmonary hypertension, obstructive pulmonary disease, and type 2 diabetes mellitus had higher prevalences within the nonsurgical group.
The results of this study suggest that nonsurgically managed OSA patients tend to have more complex medical comorbidity profiles than those managed surgically. Obesity (BMI >30) was more prevalent in the nonsurgical cohort, which may be contributory. The additive contribution of OSA needs to be further elucidated.
存在小下颌且可测量解剖气道决定因素的阻塞性睡眠呼吸暂停（OSA）患者可能代表OSA患者的一个亚组，且具有不同的合并症谱。我们的目的是比较接受上颌下颌前徙手术治疗的OSA患者与非手术治疗患者的内科合并症情况。
在这项横断面回顾性研究中，两个队列的患者均通过麻省总医院口腔颌面外科数据登记处和麻省总医院研究患者数据登记处确定。纳入标准包括记录体重指数（BMI）、呼吸暂停低通气指数、呼吸紊乱指数和/或最低血氧饱和度的临床记录。主要预测变量是所选的治疗方式：手术治疗（上颌下颌前徙）或非手术治疗。评估人口统计学信息和OSA参数。主要结局变量是每组记录的合并症数量。连续变量采用两样本t检验，分类变量采用χ²检验或Fisher精确检验。
非手术队列由71例患者组成（男性占67.6%），手术队列由51例患者组成（男性占84.3%）。描述性特征比较显示，非手术队列的平均年龄（49±9.4岁）高于手术队列（41±10.7岁，P<.001）。此外，非手术组的平均BMI更高（非手术组为42.3±11.9，手术组为29.7±5.5，P<.001）。多导睡眠图参数具有可比性，但手术队列的爱泼沃斯嗜睡量表评分更高（手术组为15.5±5.30，非手术组为9.90±6.80，P=.005）。非手术队列的合并症总数更多（非手术组为7±4，手术组为4±3，P<.001）。高血压、心血管疾病、高脂血症、肺动脉高压、阻塞性肺疾病和2型糖尿病在非手术组中的患病率更高。
本研究结果表明，非手术治疗的OSA患者往往比手术治疗的患者具有更复杂的内科合并症谱。肥胖（BMI>30）在非手术队列中更为普遍，这可能是一个促成因素。OSA的附加作用需要进一步阐明。
