Efficacy of Orthognathic Surgery in OSAS Patients: A Systematic Review and Meta-Analysis

IF 4 3区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Journal of oral rehabilitation Pub Date : 2025-01-24 DOI:10.1111/joor.13936

Syed Akbar Ali, Maria Maddalena Marrapodi, Ganiga Channaiah Shivakumar, Sahana Shivakumar, Jyothikiran Hurkadle, Marco Cicciù, Giuseppe Minervini

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Abstract

Background

Obstructive sleep apnea syndrome (OSAS) is a prevalent condition characterised by repeated episodes of partial or complete obstruction of the upper airway during sleep, leading to disrupted sleep and associated morbidities. Orthognathic surgery (OGS) has been proposed as a treatment option for OSAS, aimed at anatomically repositioning the maxillofacial structures to alleviate airway obstruction. This systematic review and meta-analysis aimed to evaluate the efficacy of OGS in reducing apnea-hypopnea index (AHI) and Epworth Sleepiness Scale (ESS) scores among OSAS patients.

Methods

We conducted a comprehensive literature search across multiple databases for studies assessing the outcomes of OGS in OSAS patients, focusing on changes in AHI and ESS scores. The inclusion criteria encompassed observational studies, cohort studies, and randomised control trials. Data extraction and quality assessment were performed independently by two reviewers. Random-effects meta-analysis was utilised to pool mean differences (MD) of AHI and ESS scores preoperatively and postoperatively, with 95% confidence intervals (CI) calculated.

Results

A total of 8 studies met the inclusion criteria, where OGS was shown to be slightly more effective in correcting OSAS than the other modalities assessed, primarily CPAP. The pooled MD for AHI demonstrated a significant reduction in scores post-OGS (MD = 29.84, 95% CI: 14.17–45.50, p < 0.0001) with substantial heterogeneity (I² = 95%). For ESS, the pooled MD indicated a non-significant reduction (MD = 1.91, 95% CI: −1.29 to 5.12, p = 0.24) with high heterogeneity (I² = 81%).

Conclusion

Orthognathic surgery appears to be an effective intervention for reducing AHI in patients with OSAS, suggesting a potential to improve the objective measures of sleep apnea. However, the effect on subjective sleepiness scores, as evaluated by ESS, was not statistically significant. The high heterogeneity among studies warrants individualised patient assessment when considering OGS for OSAS. Further research is needed to identify factors contributing to the variability of outcomes and to assess the long-term benefits and risks associated with the procedure.

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OSAS患者正颌手术的疗效：系统回顾和荟萃分析。

背景：阻塞性睡眠呼吸暂停综合征（OSAS）是一种常见病，其特征是睡眠期间反复发作的部分或完全上呼吸道阻塞，导致睡眠中断和相关发病率。正颌手术（OGS）已被提议作为OSAS的一种治疗选择，旨在解剖学上重新定位颌面部结构以减轻气道阻塞。本系统综述和荟萃分析旨在评估OGS在降低OSAS患者呼吸暂停低通气指数（AHI）和Epworth嗜睡量表（ESS）评分方面的疗效。方法：我们在多个数据库中进行了全面的文献检索，以评估OSAS患者OGS的结果，重点关注AHI和ESS评分的变化。纳入标准包括观察性研究、队列研究和随机对照试验。数据提取和质量评估由两名审稿人独立完成。采用随机效应荟萃分析，汇总术前和术后AHI和ESS评分的平均差异（MD），计算95%置信区间（CI）。结果：共有8项研究符合纳入标准，其中OGS在纠正OSAS方面比其他评估的方式（主要是CPAP）略微有效。AHI的总MD显示ogs后评分显著降低（MD = 29.84, 95% CI: 14.17-45.50, p 2 = 95%）。对于ESS，合并MD显示无显著降低（MD = 1.91, 95% CI: -1.29至5.12,p = 0.24），异质性高（I2 = 81%）。结论：正颌手术似乎是降低OSAS患者AHI的有效干预措施，表明有可能改善睡眠呼吸暂停的客观测量。然而，对主观困倦评分的影响，如ESS评估，没有统计学意义。研究之间的高度异质性保证了在考虑OSAS的OGS时对患者进行个体化评估。需要进一步的研究来确定导致结果变化的因素，并评估与该手术相关的长期利益和风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of oral rehabilitation 医学-牙科与口腔外科

CiteScore

5.60

自引率

10.30%

发文量

116

审稿时长

4-8 weeks

期刊介绍： Journal of Oral Rehabilitation aims to be the most prestigious journal of dental research within all aspects of oral rehabilitation and applied oral physiology. It covers all diagnostic and clinical management aspects necessary to re-establish a subjective and objective harmonious oral function. Oral rehabilitation may become necessary as a result of developmental or acquired disturbances in the orofacial region, orofacial traumas, or a variety of dental and oral diseases (primarily dental caries and periodontal diseases) and orofacial pain conditions. As such, oral rehabilitation in the twenty-first century is a matter of skilful diagnosis and minimal, appropriate intervention, the nature of which is intimately linked to a profound knowledge of oral physiology, oral biology, and dental and oral pathology. The scientific content of the journal therefore strives to reflect the best of evidence-based clinical dentistry. Modern clinical management should be based on solid scientific evidence gathered about diagnostic procedures and the properties and efficacy of the chosen intervention (e.g. material science, biological, toxicological, pharmacological or psychological aspects). The content of the journal also reflects documentation of the possible side-effects of rehabilitation, and includes prognostic perspectives of the treatment modalities chosen.