Patient-reported outcome measures following maxillomandibular advancement surgery in patients with obstructive sleep apnoea syndrome

Matthew J Martin; Arun Khanna; Dilip Srinivasan; Milind P Sovani

doi:10.1016/j.bjoms.2022.03.006

Patient-reported outcome measures following maxillomandibular advancement surgery in patients with obstructive sleep apnoea syndrome

Br J Oral Maxillofac Surg. 2022 Sep;60(7):963-968. doi: 10.1016/j.bjoms.2022.03.006. Epub 2022 Mar 22.

Authors

Matthew J Martin¹, Arun Khanna¹, Dilip Srinivasan², Milind P Sovani³

Affiliations

¹ Nottingham Respiratory Support and Sleep Services, Queens Medical Centre, Nottingham, UK.
² Nottingham Oral and Maxillofacial Surgery Department, Queens Medical Centre, Nottingham, UK.
³ Nottingham Respiratory Support and Sleep Services, Queens Medical Centre, Nottingham, UK. Electronic address: milind.sovani@nuh.nhs.uk.

PMID: 35667944
DOI: 10.1016/j.bjoms.2022.03.006

Abstract

Maxillomandibular advancement (MMA) is an effective treatment for obstructive sleep apnoea syndrome (OSAS) that is refractory to conventional treatment. However, it is a highly invasive procedure with several recognised side effects, and we know of few data on its effect on important patient-reported outcome measures (PROMS). Here we describe a case series of patients selected for MMA through our joint respiratory/maxillofacial surgery clinic, detailing the effect of MMA on objective physiological measurements and important PROMS. Patients with confirmed moderate/severe symptomatic OSAS who could not tolerate continuous positive airway pressure (CPAP) or mandibular advancement devices (MAD) were assessed in the clinic for consideration of MMA. Preoperative and postoperative airway measurements, apnoea/hypopnoea index (AHI), Epworth sleepiness scale (ESS) score, and quality of life (10-point Likert scale), were recorded. A customised questionnaire was administered postoperatively to assess selected psychosocial and functional domains (sleep quality, energy levels, appearance, ability to perform daily activities, and mood) and patient satisfaction using five-point Likert scales. Over an 18 month period, 39 patients were referred for consideration of MMA. Ten patients (7 men and 3 women, mean age 49.9, mean BMI 27.5) underwent surgery, which resulted in significant improvements in ESS, quality of life, AHI, and airway diameters. All patients reported improvements in all psychosocial/functional domains except appearance, in which five reported no change or worsened appearance. All subjects felt that MMA provided better symptom control than CPAP. The most commonly reported side effects were facial/lip numbness (9/10) and affected bite (6/10). MMA resulted in significant improvements in ESS, quality of life, and a range of PROMS, with a high level of patient satisfaction.

Keywords: Maxillomandibular advancement; Obstructive sleep apnoea syndrome; Patient-reported outcome measures.

MeSH terms

Continuous Positive Airway Pressure
Female
Humans
Male
Mandibular Advancement* / methods
Middle Aged
Patient Reported Outcome Measures
Quality of Life
Sleep Apnea, Obstructive* / surgery
Treatment Outcome