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Restoration of Sleep Architecture after Maxillomandibular Advancement: Success Beyond the Apnea-Hypopnea Index.

Authors
  • Liu, S Y-C1
  • Huon, L-K2
  • Ruoff, C3
  • Riley, R W1
  • Strohl, K P4
  • Peng, Z5
  • 1 Division of Sleep Surgery, Department of Otolaryngology, School of Medicine, Stanford University, Stanford, CA, USA.
  • 2 Department of Otolaryngology-Head & Neck Surgery, Cathay General Hospital, Taipei, Taiwan; School of Medicine, Fu Jen University, Taipei, Taiwan. , (Taiwan)
  • 3 Division of Sleep Medicine, School of Medicine, Stanford University, Stanford, CA, USA.
  • 4 Louis Stokes Department of Veteran Affairs Medical Center, Cleveland, OH, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
  • 5 Department of Plastic & Aesthetic Surgery, Peking University People's Hospital, Beijing, China. Electronic address: [email protected] , (China)
Type
Published Article
Journal
International journal of oral and maxillofacial surgery
Publication Date
Dec 01, 2017
Volume
46
Issue
12
Pages
1533–1538
Identifiers
DOI: 10.1016/j.ijom.2017.07.001
PMID: 28751184
Source
Medline
Keywords
License
Unknown

Abstract

While effects of maxillomandibular advancement (MMA) on respiratory parameters for patients with obstructive sleep apnea (OSA) are well described, effects on sleep architecture before and after MMA are not. A retrospective cohort analysis on sleep architecture was examined in 10 OSA patients who underwent MMA surgery between July 2013 and November 2014, and had prespecified complete polysomnography (PSG) datasets. Sleep stages were examined relative to a Western European population-based control group. All of the respiratory parameters improved significantly post MMA. Rapid eye movement (REM) latency decreased from 178.0±142.8 to 96.6±64.5min (P=0.035). %NREM (non-rapid eye movement)1 (P=0.045) and %WASO (wakefulness after sleep onset) (P=0.006) decreased, while %REM increased (P=0.002) after MMA. WASO decreased from 64.2±57min to 22.4±15.4min (P=0.017). Preoperatively, OSA subjects showed significantly lower sleep efficiency (P=0.016), sleep onset latency (P=0.015), and % REM (P<0.001) than the normative population dataset, while post MMA there was a significant decrease in %NREM1 sleep (P<0.001) and in %WASO (P<0.001). MMA results in a marked decrease in WASO and increase in REM, and to a lesser extent NREM sleep. Patients after MMA show values similar to population controls except for a lower WASO.

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