Systemic outcomes following maxillomandibular advancement for obstructive sleep apnea: systematic review and meta-analysis.

Abstract

Obstructive sleep apnea (OSA) is a common sleep disorder associated with an elevated risk of systemic comorbidities. Maxillomandibular advancement (MMA) surgery can reduce upper airway obstruction and improve sleep parameters, but its systemic health benefits remain less well characterized. This systematic review and meta-analysis was performed to synthesize evidence on the systemic health outcomes associated with MMA in patients with OSA. A comprehensive literature search was conducted in PubMed, Embase, Cochrane CENTRAL, Scopus, and Web of Science from inception through May 20, 2026. Inclusion criteria encompassed original research studies (case series, cohort studies, trials) reporting systemic health outcomes after MMA for OSA. Two reviewers independently screened and extracted data. Risk of bias was assessed using an NIH quality assessment tool. Seven studies (271 patients), with mean follow-up ranging from 5.2 months to 6.6 years, met the inclusion criteria . All studies reported significant reductions in apnea-hypopnea index postoperatively. Four studies included in a meta-analysis demonstrated statistically significant reductions in blood pressure: systolic, mean difference -8.6 mmHg (95% confidence interval -14.2 to -3.0); diastolic, mean difference -5.3 mmHg (95% confidence interval -8.5 to -2.0). MMA for OSA not only improves airway patency and sleep metrics, but is also associated with enduring systemic health benefits, including a blood pressure reduction. Limited evidence also suggests potential improvements in neurocognitive outcomes. Although the evidence suggests a positive impact, further high-quality randomized controlled trials employing rigorous outcome measures (e.g., ambulatory blood pressure monitoring) are needed to fully delineate the persistent systemic effects of maxillomandibular advancement.