Basic and patient-oriented research
Quality of Life Evaluation of Maxillomandibular Advancement Surgery for Treatment of Obstructive Sleep Apnea

https://doi.org/10.1016/j.joms.2007.11.031Get rights and content

Purpose

The purpose of this study was to investigate the quality of life (QOL) for patients who underwent maxillomandibular advancement (MMA) surgery for obstructive sleep apnea (OSA) treatment using the Functional Outcomes of Sleep Questionnaire (FOSQ). Correlation of the findings with parameters from the polysomnograph (PSG) and physical examination were also performed. No QOL studies have been carried out for MMA in OSA, and the FOSQ is the most appropriate method.

Patients and Methods

The FOSQ instrument is a survey designed to evaluate QOL in OSA and proven to be effective. All patients followed a standard prospective protocol of pre- and 6 months postoperative data collection. Clinical radiographs, PSG, FOSQ, endoscopy, and computed tomography scans were analyzed.

Results

Fifteen patients with complete data were included in the study. There was minimal change in the BMI from a preoperation mean of 32.10 to 31.50 at 6 months postoperation. The operation was 86.7% (13 of 15) successful (postoperative apnea and hypopnea index [AHI] decreased by 50% and was <20), with a significant decrease of the mean preoperation apnea-hypopnea index (AHI) of 69.12 to 13.87 postoperation (P < .0001). The minimum oxygen saturation (Lsat) correspondingly increased from a mean of 76.49 to 84.96 (P = .0001). A total of 93.3% of our patients achieved a successful QOL change based on a FOSQ score of greater than or equal to 18. There was statistically significant changes in all domains; general productivity (P = .0003), social outcome (P = .0020), activity level (P = .0008), vigilance (P = .0028), intimacy and sex (P = .0039), and the total score (P = .0002) postoperatively. Changes of Lsat and AHI were highly correlated (r = −0.728, P = .002). The magnitude of the Le Fort advancement was also found to be negatively correlated to the change in AHI (r = −0.544, P =.036). There was no correlation between the FOSQ scores and all other parameters, including both the PSG parameters (AHI and Lsat).

Conclusion

MMA remains the most effective operation for the treatment of OSA and yet no QOL studies have been carried out. The disease-specific QOL instrument (FOSQ) showed the subjective functional improvement in MMA patients. QOL instruments should be used for all surgical based treatment as they add a new dimension to the assessment of the patient and procedures.

Section snippets

Quality of Life Assessment

It has been quoted that “Quality of life in clinical medicine represents the functional effect of an illness and its consequent therapy on a patient, as perceived by the patient.”15 It has been a neglected dimension for many diseases as physicians have often been treating patients based on test results. Today, QOL is valued as an important aspect of patient care. QOL is done by assessing the various domains or components that make up the overall well-being of the patient. There are general and

Maxillomandibular Advancement

Maxillomandibular advancement surgery (MMA) is one of the most efficacious surgical procedures for OSA. It was first suggested as an alternative to tracheotomy for the treatment for OSA in 1979.20 MMA advocated by Riley and Powell meant a 10 mm advancement of the maxilla and mandible.21 The coordinated advancement of the maxilla and mandible results in retropalatal and retrolingual airway expansion.22, 23 The literature shows that this surgery yielded a 90% to 100% cure rate for the OSA21, 24,

Study Aim

The aim of this study is to measure the change in the QOL of patients undergoing maxillomandibular advancement (MMA) surgery. This change is quantified by the Functional Outcome of Sleep Questionnaire (FOSQ). The correlation of QOL improvement to other parameters such as PSG parameters, the amount of advancement during the orthognathic surgery and change in BMI was carried out.

Patients and Methods

We recruited consecutive OSA patients that were to undergo MMA at the Department of Oral and Maxillofacial Surgery (OMS), University of Alabama, Birmingham (UAB) for this Institutional Review Board (IRB)-approved study.

The inclusion criteria were: 1) patients with complete clinical, PSG, FOSQ, and radiographic records, and 2) patients who were treated with MMA with or without other adjunctive procedures. The exclusion criteria were: 1) patients who were still on nasal continuous positive airway

Results

Fifteen patients who had surgery between 2005 and 2007 were identified as suitable according to the criteria. They had a mean age of 47.93 years (range, 23 to 67 years). There were 13 Caucasian males and 2 Caucasian females. The patients had a mean preoperative BMI of 32.1 (range, 22.1 to 40.6).

The baseline preoperation PSG findings showed a mean preoperative AHI of 69.12 (range, 18.7 to 112.00) and a mean Lsat of 76.49% (range, 45 to 90.6). Fourteen patients had severe sleep apnea (AHI = >30)

MMA Success

This study supports the effectiveness of MMA as a treatment for obstructive sleep apnea, with an 86.7% success rate. Our patients had a mean preoperation BMI of 32.1 and a postoperation BMI of 31.5, which removed the chance that the success resulted from a significant loss of weight. The 2 patients that did not achieve success according to the AHI achieved large reductions in their apnea index but retained persistent hypopneas and also showed significant central apneas.

FOSQ

This is a

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