肥胖患者阻塞性睡眠呼吸暂停的上颌下颌前移：一项荟萃分析。

Maxillomandibular Advancement for Obstructive Sleep Apnea in Patients With Obesity: A Meta-Analysis.

作者信息

Diemer Tanner J, Nanu Douglas P, Nguyen Shaun A, Ibrahim Badr, Meyer Ted A, Abdelwahab Mohamed

机构信息

Department of Otolaryngology - Head and Neck Surgery, Sleep Surgery Division, Medical University of South Carolina, Charleston, South Carolina, U.S.A.

University of Arizona College of Medicine, Phoenix, Arizona, U.S.A.

出版信息

Laryngoscope. 2025 Feb;135(2):507-516. doi: 10.1002/lary.31751. Epub 2024 Sep 12.

DOI:10.1002/lary.31751

PMID:39264209

Abstract

OBJECTIVE

To systematically review polysomnographic and cephalometric data in obstructive sleep apnea (OSA) patients with obesity (body mass index [BMI] ≥30 kg/m) treated with maxillomandibular advancement (MMA).

DATA SOURCES

Scopus, PubMed, CINAHL, and The COCHRANE Library.

REVIEW METHODS

A search was performed from inception until April 3, 2024, in each database.

RESULTS

A total of 14 studies (143 subjects) were included. The mean age was 44.3 years (range: 17-69), 80.2% males (95% CI: 72.5-86.5), mean BMI of 35.3 (95% CI: 33.1-37.5), and mean duration to follow-up post-MMA was 13.7 months (95% CI: 10.1-17.3). All objective outcomes improved significantly; overall, apnea-hypopnea index (AHI) decreased by -57.3 ([95% CI: -71.5 to -43.2], p < 0.0001) lowest oxygen saturation (LSAT) increased by 14.1% ([95% CI: 9.9 to 18.3], p < 0.0001), and Epworth Sleepiness Scale (ESS) decreased by -9.4 ([95% CI: -13.5 to -5.2], p < 0.0001). Surgical cure was 39.2% (95% CI: 20.3-60.0), and surgical success was 85.6% (95% CI: 77.8-91.5). Comparing percent reduction in class 3 obesity (-92.9%) as compared to class 1 (-85.5%) and class 2 (-83.6%) exhibited a significant difference (1 vs 3 p = 0.0012, 2 vs 3 p = 0.015).

CONCLUSIONS

Our findings suggest that MMA significantly improves subjective and objective outcomes in OSA amongst patients with obesity with results comparable to the overall population. Success rates remained above 80% in studies with the highest mean BMI. In addition, patients with class 3 obesity yielded a significantly increased benefit based on percent reduction in AHI compared with class 1 and 2.

LEVEL OF EVIDENCE

1 Laryngoscope, 135:507-516, 2025.

摘要

目的

系统回顾接受上颌下颌前移术（MMA）治疗的肥胖（体重指数[BMI]≥30kg/m²）阻塞性睡眠呼吸暂停（OSA）患者的多导睡眠图和头影测量数据。

数据来源

Scopus、PubMed、CINAHL和Cochrane图书馆。

综述方法

在每个数据库中从建库至2024年4月3日进行检索。

结果

共纳入14项研究（143名受试者）。平均年龄为44.3岁（范围：17 - 69岁），男性占80.2%（95%置信区间：72.5 - 86.5），平均BMI为35.3（95%置信区间：33.1 - 37.5），MMA术后平均随访时间为13.7个月（95%置信区间：10.1 - 17.3）。所有客观指标均显著改善；总体而言，呼吸暂停低通气指数（AHI）下降了-57.3（[95%置信区间：-71.5至-43.2]，p < 0.0001），最低血氧饱和度（LSAT）提高了14.1%（[95%置信区间：9.9至18.3]，p < 0.0001），爱泼沃斯嗜睡量表（ESS）下降了-9.4（[95%置信区间：-13.5至-5.2]，p < 0.0001）。手术治愈率为39.2%（95%置信区间：20.3 - 60.0），手术成功率为85.6%（95%置信区间：77.8 - 91.5）。与1级肥胖（-85.5%）和2级肥胖（-83.6%）相比，3级肥胖的减少百分比（-92.9%）存在显著差异（1级与3级p = 0.0012，2级与3级p = 0.015）。