Does the medical comorbidity profile of OSA patients treated with maxillomandibular advancement differ from that of OSA patients managed nonsurgically?

Publication date: Available online 31 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Richard Ngo, Elaina Pullano, Zachary S. Peacock, Edward T. Lahey, Meredith August
PurposeObstructive sleep apnea (OSA) patients with retrognathia and measurable anatomic airway determinants may represent a subset of OSA patients and have distinct comorbidity profiles. Our aim is to compare the medical comorbidities of OSA patients managed surgically with maxillomandibular advancement (MMA) to those of non-surgical patients.Patients and MethodsThis is a cross-sectional retrospective study. Subjects for both cohorts were identified through the Massachusetts General Hospital Oral and Maxillofacial Surgery(OMS) data registry and the MGH Research Patient Data Registry(RPDR). Inclusion criteria consisted of clinical records documenting BMI, apnea-hypopnea index(AHI), respiratory disturbance index(RDI), and/or O2 nadir. The primary predictor variable was the treatment modality chosen: surgical(MMA) or nonsurgical. Demographic information and OSA parameters were evaluated. The primary outcome variable was the number of documented comorbidities in each group. Two-sample t-tests were used for continuous variables. Chi-square or Fisher's exact tests were used for categorical variables.ResultsThe non-surgical cohort consisted of 71 subjects(67.6% male) and the surgical cohort of 51 subjects(84.3% male). Comparison of descriptive characteristics showed that the nonsurgical cohort had a higher average age(49±9.4) than the surgical cohort(41±10.7; P< .001). A higher average BMI was also present among the nonsurgical group(42.3±11.9 nonsurgical vs. 29.7±5.5 surgical; P<.001). Polysomnogram parameters were comparable with exception of a higher Epworth Sleepiness Scale (ESS) in the surgical cohort(15.5±5.30 surgical vs. 9.90±6.80 nonsurgical; P=.005). The non-surgical cohort had a higher total number of comorbidities(7± 4 nonsurgical vs. 4± 3 surgical; P<0.001). Hypertension, cardiovascular disease, hyperlipidemia, pulmonary hypertension, obstructive pulmonary disease, and type 2 diabetes mellitus (DM) had higher prevalence within the non-surgical group.ConclusionThe results of this study suggest that non-surgically managed OSA patients tend to have more complex medical comorbidity profiles than those managed surgically. Obesity (BMI>30) was more prevalent in the nonsurgical cohort, which may be contributory. The additive contribution of OSA needs to be further elucidated.



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