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

ABSTRACT

OBJECTIVE: To systematically review polysomnographic and cephalometric data in obstructive sleep apnea (OSA) patients with obesity (body mass index [BMI] ≥30 kg/m2) 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, 2024.