“Silent” Sleep Apnea in Dentofacial Deformities and Prevalence of Daytime Sleepiness after Orthognathic/Intranasal Surgery

Publication date: Available online 11 September 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Jeffrey C. Posnick, Anayo Adachie, Neeru Singh, Elbert Choi
PurposeThe purposes of this study were to: determine the occurrence of undiagnosed "silent" obstructive sleep apnea (OSA) in dentofacial deformity (DFD) subjects at initial surgical presentation; and to report on the level of daytime sleepiness in DFD subjects with OSA and chronic obstructed nasal breathing (CONB) after undergoing bimaxillary, chin, and intranasal surgery.MethodsA retrospective cohort study of subjects with a bimaxillary DFD and CONB was implemented. Subjects were divided into Group I (no OSA) and Group II (OSA). Group II was further subdivided into Group IIa (referred with polysomnogram [PSG] confirmed OSA) and Group IIb (diagnosis of OSA only after surgical consultation/airway evaluation and positive PSG). Group II subjects were analyzed > 1 year after surgery (range 1-10 years) for daytime sleepiness using the Epworth Sleepiness Survey (ESS). Subjects with postoperative excessive daytime sleepiness (EDS) were assessed for risk factors and continued need for OSA treatment. Subjects in Group II were studied to determine which DFD patterns were most associated with OSA. We compared the prevalence of OSA between our study population and the general population.ResultsTwo-hundred and sixty-two subjects met the inclusion criteria. Twenty-three percent (60/262) had PSG confirmed OSA (Group II). This was much higher than found in the general population. Seven percent (19/262) were known to have OSA at initial surgical consultation (Group IIa). An additional 16% (41/262) were later confirmed by PSG to have OSA (Group IIb). Primary mandibular deficiency and short face DFDs were most likely to have OSA (p=0.000 and 0.001, respectively). In Group II, 91% (55/60) rated their daytime sleepiness as "Not Sleepy" at a minimum of 1 year after surgery. A significant association was found between Group II subjects with post-operative EDS ("sleepy" or "very sleepy") and a preoperative BMI level of overweight (p=0.026).ConclusionOur study found "silent" OSA to be frequent in the DFD population. The prevalence of OSA in DFD subjects exceeded that estimated in the general population, with retrusive jaw patterns most affected. In DFD subjects also presenting with OSA and CONB, we confirmed low levels of daytime sleepiness long-term after simultaneous bimaxillary orthognathic, chin, and intranasal surgery.



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