Mandibular Advancement for Adult Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

Publication date: Available online 13 October 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Michael W. Noller, Christian Guilleminault, Christopher Gouveia, Douglas Mack, Charles Vivian, Jose Abdullatif, Stefano Mangili, Stanley Yung Liu, Soroush Zaghi, Macario Camacho
ObjectivesPatients with mandibular insufficiency can be predisposed to obstructive sleep apnea (OSA). The objective of this study was to systematically review the international literature for mandibular advancement surgeries (MAS) as treatment for adult OSA, and then to perform a meta-analysis.MethodsFour authors searched five databases from the inception of each database through April 5, 2017. The PRISMA statement was followed.Results972 studies were screened, 84 were downloaded, and 11 (57 patients) met criteria. In patients with mandibular insufficiency, MAS reduced apnea-hypopnea index (AHI) (50 patients) from 45.9±24.7 to 6.2±10.4 events/hr (87% decrease). The lowest oxygen saturation (LSAT) (55 patients) increased from 71.9±14.6% to 89.0±11.0% The AHI mean difference was -34.8 events/hr [95% CI -43.9, -25.8]. The AHI standardized mean difference was -1.8 [95% CI -2.5, -1.2] (indicating a large magnitude of effect). Surgical cure was seen in 75% of those with >16mm of mandibular advancement vs. 35% of those with <16mm of advancement [Odds Ratio 5.5; 95% CI 1.06-28.4; Chi Square p = 0.035].ConclusionsThe current literature supports isolated mandibular advancement as an efficacious treatment modality for adult OSA in select patients with mandibular insufficiency.



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