Apnea hypopnea index in healthy Class III patients treated with intraoral vertical ramus osteotomy: a prospective cohort study.

Publication date: Available online 24 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Elisabeth Schilbred Eriksen, Shashi Gulati, Ketil Moen, Per Johan Wisth, Sigbjørn Løes

ABSTRACT

Purpose

To assess if mandibular setback surgery by intraoral vertical ramus osteotomy (IVRO) induces obstructive apnea and hypopnea in healthy, Class III patients without a history of respiratory dysfunction. The authors hypothesized that apnea hypopnea index (AHI) did not exceed 5 events/hour after surgery.

Methods

A prospective cohort study was conducted. The sample was composed of healthy Class III patients without a history of obstructive sleep apnea (OSA) treated with isolated mandibular setback surgery by the IVRO procedure at a university hospital. In-home respiratory sleep recordings (Nox T3®) and self-administered questionnaires were obtained before and at least three months after surgery. AHI was the primary outcome variable. Other study variables were peripheral capillary oxygen saturation (SpO₂), oxygen desaturation index (ODI), snore index, body mass index (BMI), Epworth Sleepiness Scale (ESS) and Oral Impact on Daily Performance (OIDP) index. Descriptive and bivariate statistics were computed and significance level was set to 0.05.

Results

The sample was composed of eight patients. Mean age at surgery was 23.2 years (range: 18.2-33.4 years). Mean surgical setback was 4.3 mm (range: 2.5-7.4 mm). Mean BMI was 24.2 kg/m² (SE: 1.3) and 23.9 kg/m² (SE: 1.4) at the pre- and post-surgical sleep recording respectively. Mean AHI was 1.3 (SE: 0.3, range: 0.1-2.5) events/hour before surgery and 1.8 (SE: 0.4, range: 0.3-3.3) events/hour after surgery. No statistically significant changes in neither AHI (p=0.412), SpO₂ (p=0.443), ODI (p=0.194), snore index (p=0.363) nor ESS (p=0.812) were observed. The patients' self-reported oral health-related quality of life statistically significantly improved after surgery (p=0.034).

Conclusion

Mandibular setback surgery with the IVRO procedure in the range of 2.5-7.4 mm did not induce OSA measured as AHI above five events per hour in the eight young, healthy, adult Class III patients presented in this study. More studies including larger patient samples are needed.

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