Positive airway pressure settings do not predict outcomes of maxillomandibular advancement surgery in the treatment of obstructive sleep apnea.

Abstract

Purpose: The purpose of this study was to determine if the therapeutic continuous positive airway pressure (CPAP) setting identified during pre-surgical CPAP titration polysomnogram (PSG) is predictive of surgical success after MMA in adults with OSA.

Methods: This multi-institutional retrospective study evaluated adults treated for OSA with MMA between 2000 and 2020 at Michigan Medicine and Massachusetts General Hospital. Patients included were those with a diagnosis of moderate-severe OSA (AHI > 15), a pre-operative CPAP titration PSG, and available pre-operative and postoperative PSGs. The primary predictor variable was the recommended CPAP setting from the pre-op titration PSG. Secondary predictor variables included preoperative oxygen saturation nadir, and hypoxic burden. The primary outcome variable was surgical success (achieving an AHI of < 20 and >/=50% reduction in AHI). The secondary outcome variable was change in AHI. Logistic and linear regression were used to model outcomes. Unadjusted and bivariable adjusted models were performed for predictors. Significance was set to P <.05.

Results: 31 subjects were included in this study (25 males, average age 42.9 ± 9.67 years). Mean pre-surgical CPAP titration setting was 10.4 cm H2O. On mixed model regression, recommended CPAP setting did not predict surgical success (adjusted ß = 0.93, P =.56), nor change in AHI (adjusted ß = 0.35, P =.51). In the latter model, age was found to be statistically significant, with each increased year of age increasing the postop AHI by 0.51/hr (P =.004). Hypoxic burden was also significant and positively correlated with AHI (adjusted ß = 0.90, P =.02).

Conclusion: MMA remains an effective treatment modality for carefully selected patients with OSA, however, pre-operative therapeutic CPAP values were not a reliable predictor of surgical success.