Comparison of phenotypic characteristics between responders and non-responders to treatment for obstructive sleep apnea with maxillomandibular advancement in adults

Background and objective: 3D cone-beam computed tomography (CBCT) images obtained presurgery and postsurgery can expand our knowledge of predictors of successful maxillomandibular advancement (MMA) for treatment of adult patients with obstructive sleep apnea (OSA). This prospective cohort study aimed to identify predictors of successful MMA surgery for adults with OSA using anatomical CBCT measurements. Methods: Analysis of anatomical outcomes was conducted by comparing postoperative with preoperative measures from 3D CBCT images. Preoperative and postoperative variables of responders were compared with non-responders. A postoperative AHI <10 and a reduction of >50 % identified responders. Results: A total of 50 patients met the inclusion criteria. The mean (SD) AHI was 32.3 (21.0). The mean (SD) age was 32.4 (9.2) years; 72 % were male; mean (SD) body mass index was 22.4 (3.2) kg/m². Mean (SD) time of follow-up was 2.0 (1.5) years. Thirty participants were identified as responders. Compared with preoperative characteristics of non-responders, AHI was significantly lower, the maxilla was shorter, the hyoid position was higher and more forward, tongue and soft palate were shorter, and oropharyngeal airway space was wider and larger (all p < .05). Multivariate logistic regression revealed preoperative variables of maxillary and mandibular width, tongue length, airway length, oropharyngeal anteroposterior dimension, and the surgical variable for degree of mandibular advancement were predictors of successful treatment of OSA with MMA. Conclusions and relevance: Our findings suggest preoperative anatomical characteristics, as well as required surgical advancement should be evaluated when considering MMA for treatment of adults with OSA. The application of 3D CBCT provided detailed information on anatomical characteristics that should be an essential tool when evaluating adult patients with OSA who will benefit from treatment with MMA.