Pullano Elaina, Ngo Richard, Peacock Zachary S, Lahey Edward T, August Meredith
Student, Harvard School of Dental Medicine, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
Resident, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
J Oral Maxillofac Surg. 2019 May;77(5):1044-1049. doi: 10.1016/j.joms.2018.12.006. Epub 2018 Dec 17.
This study investigated whether patients with documented obstructive sleep apnea (OSA) who have a decrease in apnea-hypopnea index (AHI) score and self-reported symptoms after maxillomandibular advancement (MMA) with genial tubercle advancement (GTA) also have a change in their medical comorbidity profile a minimum of 2 years postoperatively. Changes in the quantity of medical diagnoses, quantity of prescription medications, and average weight and body mass index (BMI) were assessed.
This is a retrospective cohort study of patients with a diagnosis of OSA (AHI score >5 on polysomnogram [PSG]) treated at the Massachusetts General Hospital (Boston, MA) with MMA and GTA from 2001 through 2015. Patients were identified through the oral and maxillofacial surgery patient data registry. Inclusion criteria were the availability of complete clinical records and requisite follow-up time. The primary predictor variable was operative status (preoperative or postoperative). The primary outcome variables were comorbidities reported to be associated with OSA and identified in the authors' previous study (J Oral Maxillofac Surg 76:1999.e1, 2018). Two-tailed paired t tests were used for continuous variables and χ or Fisher exact tests were used for categorical variables.
Forty-six patients (39 men, 7 women) met the inclusion criteria. Average weight (206.7 ± 42.4 lb preoperatively; 213.8 ± 41.7 lb postoperatively; P = .014) and average BMI (30.0 ± 5.7 kg/m preoperatively; 30.9 ± 5.3 kg/m postoperatively; P = .041) significantly increased in patients postoperatively. No meaningful changes in the number of medical diagnoses or number of prescription medications were noted. Stratification of patients by BMI showed significant increases in weight (188.6 ± 21.5 lb preoperatively; 200.1 ± 27.9 lb postoperatively; P = .0085) and BMI (27.1 ± 1.44 kg/m preoperatively; 28.9 ± 3.52 kg/m postoperatively; P = .013) only in "overweight" patients. No other parameters were found to be relevant.
Subjective improvement in OSA symptoms was reported by all patients and objective PSG improvement was reported for 71% of those evaluated. However, no relevant changes in comorbidity profile were found, suggesting that the medical conditions commonly observed with OSA are likely of multifocal etiology.
本研究调查了记录在案的阻塞性睡眠呼吸暂停（OSA）患者，在接受下颌前徙术（MMA）联合颏结节前徙术（GTA）后，呼吸暂停低通气指数（AHI）评分和自我报告症状有所改善，其术后至少2年的医疗合并症情况是否也发生了变化。评估了医疗诊断数量、处方药数量以及平均体重和体重指数（BMI）的变化。
这是一项回顾性队列研究，研究对象为2001年至2015年在马萨诸塞州总医院（波士顿，马萨诸塞州）接受MMA和GTA治疗的OSA诊断患者（多导睡眠图[PSG]上AHI评分>5）。通过口腔颌面外科患者数据登记处识别患者。纳入标准为有完整的临床记录和必要的随访时间。主要预测变量为手术状态（术前或术后）。主要结局变量为先前研究（《口腔颌面外科杂志》76:1999.e1，2018）中报道的与OSA相关的合并症。连续变量采用双尾配对t检验，分类变量采用χ²检验或Fisher精确检验。
46例患者（39例男性，7例女性）符合纳入标准。患者术后平均体重（术前206.7±42.4磅；术后213.8±41.7磅；P = 0.014）和平均BMI（术前30.0±5.7kg/m²；术后30.9±5.3kg/m²；P = 0.041）显著增加。医疗诊断数量或处方药数量未发现有意义的变化。按BMI对患者进行分层显示，仅“超重”患者的体重（术前188.6±21.5磅；术后200.1±27.9磅；P = 0.0085）和BMI（术前27.1±1.44kg/m²；术后28.9±3.52kg/m²；P = 0.013）显著增加。未发现其他参数具有相关性。
所有患者均报告OSA症状有主观改善，71%接受评估的患者报告PSG有客观改善。然而，未发现合并症情况有相关变化，这表明OSA常见的医疗状况可能病因多灶。
