Al-Bayyati Haya H R, Hassing Gert-Jan, van der Hoeve Egbert P, Koppendraaier Laurens, de Ruiter Maurits H T
Medical Student, Department of Oral and Maxillofacial Surgery, Diakonessenhuis Utrecht, Utrecht, the Netherlands; Medical Student, Faculty of Medicine, University of Amsterdam, Amsterdam, the Netherlands.
Oral and Maxillofacial Surgery Resident, Department of Oral and Maxillofacial Surgery, Utrecht University Medical Center, Utrecht, the Netherlands.
J Oral Maxillofac Surg. 2025 May;83(5):543-557. doi: 10.1016/j.joms.2025.01.010. Epub 2025 Jan 28.
Maxillomandibular advancement (MMA) surgery for obstructive sleep apnea (OSA) has shown to be effective according to objective measures; however, patient-reported outcome measures (PROMs), especially health-related quality of life (HRQoL), are also crucial but have not been systematically assessed in relation to MMA surgery for OSA yet. Therefore, this study aims to conduct a systematic review on the effect of MMA surgery on PROMs focusing on HRQoL in patients with OSA.
A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines with a literature search performed in PubMed and Medline to identify relevant studies from database inception to May 2024 evaluating PROMs focusing on HRQoL in adult OSA patients treated with MMA surgery. The primary variables are the PROMs outcomes. Screening and eligibility assessments were carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis framework, and study quality was evaluated using the ROBINS-I tool. The data extraction for the meta-analysis included PROMs outcomes and was carried out in SPSS using a fixed-effects model to report effect sizes as mean differences.
Thirty-three studies were screened of which 12 were included in this systematic review encompassing 317 patients. The studies reported PROMs in a heterogeneous manner, but MMA consistently showed an improvement postoperatively in mean differences. In the most used PROMs instruments MMA surgery was associated with a 5.35-point improvement in the Epworth Sleepiness Scale (95% CI -6.57 to -4.14; Z = -8.62; P < .001), a 3.96-point improvement on the Functional Outcomes of Sleep Questionnaire (95% CI 3.11, 4.80; Z = 11.60; P < .001) and an improvement in all domains of the Short Form 36 Health Survey.
MMA surgery for patients with OSA shows significant improvements in PROMs related to quality of life. The PROMs are positive, demonstrating satisfaction across various domains. This indicates that MMA surgery is well received by patients and results in clinically meaningful improvements in PROMs related to HRQoL.
根据客观指标，上颌下颌前移（MMA）手术治疗阻塞性睡眠呼吸暂停（OSA）已被证明是有效的；然而，患者报告结局指标（PROMs），尤其是健康相关生活质量（HRQoL），也至关重要，但尚未针对OSA的MMA手术进行系统评估。因此，本研究旨在对MMA手术对以OSA患者的HRQoL为重点的PROMs的影响进行系统评价。
按照系统评价和Meta分析的首选报告项目指南进行系统评价和Meta分析，在PubMed和Medline中进行文献检索，以识别从数据库建立到2024年5月评估接受MMA手术治疗的成年OSA患者以HRQoL为重点的PROMs的相关研究。主要变量是PROMs结局。根据系统评价和Meta分析框架的首选报告项目进行筛选和资格评估，并使用ROBINS-I工具评估研究质量。Meta分析的数据提取包括PROMs结局，并在SPSS中使用固定效应模型进行，以报告效应大小为均值差异。
共筛选了33项研究，其中12项纳入本系统评价，涵盖317例患者。这些研究以异质性方式报告了PROMs，但MMA术后均值差异始终显示出改善。在最常用的PROMs工具中，MMA手术与Epworth嗜睡量表改善5.35分相关（95%CI -6.57至-4.14；Z = -8.62；P <.001），睡眠问卷功能结局改善3.96分（95%CI 得3.11，4.80；Z = 11.60；P <.001），以及简短健康调查问卷所有领域均有改善。
OSA患者的MMA手术在与生活质量相关的PROMs方面显示出显著改善。PROMs呈阳性，表明在各个领域均有满意度。这表明MMA手术受到患者的欢迎，并在与HRQoL相关的PROMs方面带来了具有临床意义的改善。
