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Maxillomandibular advancement and tracheostomy for morbidly obese obstructive sleep apnea: a systematic review and meta-analysis
- Source :
- Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 152(4)
- Publication Year :
- 2014
-
Abstract
- The objective of this study is to systematically review polysomnography data and sleepiness in morbidly obese (body mass index [BMI] ≥40 kg/m(2)) patients with obstructive sleep apnea (OSA) treated with either a maxillomandibular advancement (MMA) or a tracheostomy and to evaluate the outcomes.MEDLINE, Scopus, Web of Science, and the Cochrane Library.A search was performed from inception through April 8, 2014, in each database.Six maxillomandibular advancement studies (34 patients, age 42.42 ± 9.13 years, mean BMI 44.88 ± 4.28 kg/m(2)) and 6 tracheostomy studies (14 patients, age 52.21 ± 10.40 years, mean BMI 47.93 ± 7.55 kg/m(2)) reported individual patient data. The pre- and post-MMA means ± SDs for apnea-hypopnea indices were 86.18 ± 33.25/h and 9.16 ± 7.89/h (P.00001), and lowest oxygen saturations were 66.58% ± 16.41% and 87.03% ± 5.90% (P.00001), respectively. Sleepiness following MMA decreased in all 5 patients for whom it was reported. The pre- and posttracheostomy mean ± SD values for apnea indices were 64.43 ± 41.35/h and 1.73 ± 2.68/h (P = .0086), oxygen desaturation indices were 69.20 ± 26.10/h and 41.38 ± 36.28/h (P = .22), and lowest oxygen saturations were 55.17% ± 16.46% and 79.83% ± 4.36% (P = .011), respectively. Two studies reported outcomes for Epworth Sleepiness Scale for 5 patients, with mean ± SD values of 18.80 ± 4.02 before tracheostomy and 2.80 ± 2.77 after tracheostomy (P = .0034).Data for MMA and tracheostomy as treatment for morbidly obese, adult OSA patients are significantly limited. We caution surgeons about drawing definitive conclusions from these limited studies; higher level studies are needed.
- Subjects :
- Adult
medicine.medical_specialty
Web of science
medicine.medical_treatment
Polysomnography
Comorbidity
Morbidly obese
Tracheostomy
medicine
Maxilla
Humans
Sleep Apnea, Obstructive
medicine.diagnostic_test
business.industry
Maxillomandibular advancement
Patient data
medicine.disease
Surgery
Obesity, Morbid
Osteotomy
Obstructive sleep apnea
Otorhinolaryngology
Anesthesia
Meta-analysis
business
Body mass index
Mandibular Advancement
Subjects
Details
- ISSN :
- 10976817
- Volume :
- 152
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
- Accession number :
- edsair.doi.dedup.....3fe7cf18453aa43c7514e142dc3f0bd5