Maxillomandibular Advancement for Obstructive Sleep Apnea in Patients With Obesity: A Meta‐Analysis

Abstract

ObjectiveTo systematically review polysomnographic and cephalometric data in obstructive sleep apnea (OSA) patients with obesity (body mass index [BMI] ≥30 kg/m2) treated with maxillomandibular advancement (MMA).Data SourcesScopus, PubMed, CINAHL, and The COCHRANE Library.Review MethodsA search was performed from inception until April 3, 2024, in each database.ResultsA total of 14 studies (143 subjects) were included. The mean age was 44.3 years (range: 17–69), 80.2% males (95% CI: 72.5–86.5), mean BMI of 35.3 (95% CI: 33.1–37.5), and mean duration to follow‐up post‐MMA was 13.7 months (95% CI: 10.1–17.3). All objective outcomes improved significantly; overall, apnea‐hypopnea index (AHI) decreased by −57.3 ([95% CI: −71.5 to −43.2], p < 0.0001) lowest oxygen saturation (LSAT) increased by 14.1% ([95% CI: 9.9 to 18.3], p < 0.0001), and Epworth Sleepiness Scale (ESS) decreased by −9.4 ([95% CI: −13.5 to −5.2], p < 0.0001). Surgical cure was 39.2% (95% CI: 20.3–60.0), and surgical success was 85.6% (95% CI: 77.8–91.5). Comparing percent reduction in class 3 obesity (−92.9%) as compared to class 1 (−85.5%) and class 2 (−83.6%) exhibited a significant difference (1 vs 3 p = 0.0012, 2 vs 3 p = 0.015).ConclusionsOur findings suggest that MMA significantly improves subjective and objective outcomes in OSA amongst patients with obesity with results comparable to the overall population. Success rates remained above 80% in studies with the highest mean BMI. In addition, patients with class 3 obesity yielded a significantly increased benefit based on percent reduction in AHI compared with class 1 and 2.Level of Evidence1 Laryngoscope, 2024