Obstructive Sleep Apnea: A Case Report and Literature Review
DOI:
https://doi.org/10.15517/3t3th077Keywords:
Obstructive sleep apnea; Orthognatic surgery; Maxillomandibular advancement; Le Fort type I osteotomy; Counterclockwise rotation; Bilateral sagittal split osteotomy; Case report.Abstract
Obstructive sleep apnea (OSA) is a sleep disorder caused by upper airway obstruction during sleep, leading to airflow interruption. Despite its increasing prevalence, OSA remains largely underdiagnosed. This literature review and case report aims to update the dental community on the diagnosis and management of OSA while presenting the case of a patient treated with a multidisciplinary approach including surgical intervention. We report the case of a 27-year-old patient with a chief complaint of respiratory impairment, snoring, and unaesthetic chin projection, associated with daytime sleepiness, headaches, severe snoring, fatigue, and extreme exhaustion. The patient presented with a BMI of 32 kg/m², a class II dentofacial deformity, mandibular retrognathism, and moderate OSA (apnea-hypopnea index: 22), and was treated with maxillomandibular advancement (MMA) with counterclockwise rotation of the occlusal plane, genioplasty and lifestyle modifications. The intervention resulted in a reduction of the Apnea-Hypopnea Index to 0.5 events/hour and a favorable esthetic and functional outcome. Long-term weight management remains crucial to prevent recurrence, while annual follow-up ensures appropriate monitoring. This case supports existing evidence on the benefits of surgical correction in appropriately selected patients and highlights the importance of multidisciplinary management in OSA treatment.
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Fujita S., Conway W., Zorick F., Roth T. Surgical correction of anatomical abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. 1981; 89 (6): 923-34. DOI: https://doi.org/10.1177/019459988108900609
Schwartz M., Acosta L., Hung Y.L., Padilla M., Enciso R. Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients: a systematic review and meta-analysis. Vol. 22, Sleep and Breathing. Springer Verlag; 2018. p. 555-68. DOI: https://doi.org/10.1007/s11325-017-1590-6
William Arnett G., Bergman R.T., Santa Barbara M. Facial keys to orthodontic diagnosis and treatment planning-part H. Vol. 103, American Journal of Orthodontics and Dentofacial Orthopedics Founded in. 1915. DOI: https://doi.org/10.1016/S0889-5406(05)81791-3
Gottsauner-Wolf S., Laimer J., Bruckmoser E. Posterior Airway Changes Following Orthognathic Surgery in Obstructive Sleep Apnea. Vol. 76, Journal of Oral and Maxillofacial Surgery. W.B. Saunders; 2018. p. 1093.e1-1093.e21. DOI: https://doi.org/10.1016/j.joms.2017.11.035
Sharples L.D., Clutterbuck-James A.L., Glover M.J., Bennett M.S., Chadwick R., Pittman M.A., et al. Meta-analysis of randomised controlled trials of oral mandibular advancement devices and continuous positive airway pressure for obstructive sleep apnoea-hypopnoea. Vol. 27, Sleep Medicine Reviews. W.B. Saunders Ltd; 2016. p. 108-24. DOI: https://doi.org/10.1016/j.smrv.2015.05.003
Gottlieb D.J., Punjabi N.M. Diagnosis and Management of Obstructive Sleep Apnea: A Review. JAMA - J Am Med Assoc. 2020 Apr 14; 323 (14): 1389-400.
AlRumaih H.S., Baba N.Z., AlShehri A., AlHelal A., Al-Humaidan A. Obstructive Sleep Apnea Management: An Overview of the Literature. Vol. 27, Journal of Prosthodontics. Blackwell Publishing Inc.; 2018. p. 260-5. DOI: https://doi.org/10.1111/jopr.12530
Aarab G., Lobbezoo F., Hamburger H.L., Naeije M. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: A randomized, placebo-controlled trial. Respiration. 2011 Apr; 81 (5): 411-9.
Choi J.W., Jeong W.S., Kang M.K., Lee J.Y., Chung Y.S. Counterclockwise Rotational Orthognathic Surgery for the Obstructive Sleep Apnea in Class II Dentofacial Deformity: Polysomnography and 3D Computed Tomographic Analysis. Ann Plast Surg. 2021 Jun 1; 86 (6): 640-6. DOI: https://doi.org/10.1097/SAP.0000000000002580
Holty J.E.C., Guilleminault C. Maxillomandibular advancement for the treatment of obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev [Internet]. 2010; 14 (5): 287-97. Available from: http://dx.doi.org/10.1016/j.smrv.2009.11.003 DOI: https://doi.org/10.1016/j.smrv.2009.11.003
Cheng A. Genioglossus and Genioplasty Advancement. Vol. 27, Atlas of the Oral and Maxillofacial Surgery Clinics of North America. W.B. Saunders; 2019. p. 23-8. DOI: https://doi.org/10.1016/j.cxom.2018.11.008
John C.R., Gandhi S., Sakharia A.R., James T.T. Maxillomandibular advancement is a successful treatment for obstructive sleep apnoea: a systematic review and meta-analysis. Vol. 47, International Journal of Oral and Maxillofacial Surgery. Churchill Livingstone; 2018. p. 1561-71. DOI: https://doi.org/10.1016/j.ijom.2018.05.015
Soose R.J. Novel Surgical Approaches for the Treatment of Obstructive Sleep Apnea. Vol. 11, Sleep Medicine Clinics. W.B. Saunders; 2016. p. 189-202. DOI: https://doi.org/10.1016/j.jsmc.2016.01.006
Caples S.M., Rowley J.A., Prinsell J.R., Pallanch J.F., Elamin M.B., Katz S.G., et al. Surgical Modifications of the Upper Airway for Obstructive Sleep Apnea in Adults: A Systematic Review and Meta-Analysis. Sleep. 2010; 33 (10): 1396-407. DOI: https://doi.org/10.1093/sleep/33.10.1396
Zhou A., Li H., Wang X., Zhang J., Zhang Y., He J., et al. Preliminary comparison of the efficacy of several surgical treatments based on maxillomandibular advancement procedures in adult patients with obstructive sleep apnoea: a systematic review and network meta-analysis. Eur Arch Oto-Rhino-Laryngology. 2020 Feb 1; 278 (2): 543-55. DOI: https://doi.org/10.1007/s00405-020-06287-y
Lin H.C., Weaver E.M., Lin H.S., Friedman M. Multilevel Obstructive Sleep Apnea Surgery. Adv Otorhinolaryngol. 2017; 80: 109-15. DOI: https://doi.org/10.1159/000470879
Zaghi S., Holty J.E.C., Certal V., Abdullatif J., Guilleminault C., Powell N.B., et al. Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea A Meta-analysis. JAMA Otolaryngol - Head Neck Surg. 2015; 142 (1): E1-9. DOI: https://doi.org/10.1001/jamaoto.2015.2678
Ronchi P., Novelli G., Colombo L., Valsecchi S., Oldani A., Zucconi M., et al. Effectiveness of maxillo-mandibular advancement in obstructive sleep apnea patients with and without skeletal anomalies. Int J Oral Maxillofac Surg. 2010 Jun; 39 (6): 541-7. DOI: https://doi.org/10.1016/j.ijom.2010.03.006
Hupp J.R., Ellis E., Tucker M.R. Contemporary Oral and Maxillofacial Surgery. Sixth. St. Louis: ElSevier; 2014. 532-535 p.
Faria A.C., Xavier S.P., Silva S.N., Trawitzki L.V.V., De Mello-Filho F.V. Cephalometric analysis of modifications of the pharynx due to maxillo-mandibular advancement surgery in patients with obstructive sleep apnea. Int J Oral Maxillofac Surg [Internet]. 2013; 42 (5): 579-84. Available from: http://dx.doi.org/10.1016/j.ijom.2012.10.002 DOI: https://doi.org/10.1016/j.ijom.2012.10.002
Butterfield K.J., Marks P.L.G., McLean L., Newton J. Linear and Volumetric Airway Changes After Maxillomandibular Advancement for Obstructive Sleep Apnea. J Oral Maxillofac Surg. 2015 Jun 1; 73 (6): 1133-42. DOI: https://doi.org/10.1016/j.joms.2014.11.020
Abad V.C., Guilleminault C. Pharmacological Treatment of Obstructive Sleep Apnea. Vol. 17, Current Pharmaceutical Design. 2011. DOI: https://doi.org/10.2174/138161211796197106
Rueda J.R., Mugueta-Aguinaga I., Vilaró J., Rueda-Etxebarria M. Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea. Cochrane Database Syst Rev. 2020; 11 (11). DOI: https://doi.org/10.1002/14651858.CD013449.pub2
Camacho M., Certal V., Abdullatif J., Zaghi S., Ruoff C.M., Capasso R., et al. Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. Sleep. 2015; 38 (5): 669-675A. DOI: https://doi.org/10.5665/sleep.4652
Gupta R.J., Kademani D., Stanley Y.C.L. Upper Airway (Hypoglossal Nerve) Stimulation for Treatment of Obstructive Sleep Apnea. Vol. 27, Atlas of the Oral and Maxillofacial Surgery Clinics of North America. W.B. Saunders; 2019. p. 53-8. DOI: https://doi.org/10.1016/j.cxom.2018.11.004
Zhu Y., Long H., Jian F., Lin J., Zhu J., Gao M., et al. The effectiveness of oral appliances for obstructive sleep apnea syndrome: A meta-analysis. Vol. 43, Journal of Dentistry. Elsevier Ltd; 2015. p. 1394-402. DOI: https://doi.org/10.1016/j.jdent.2015.10.008
Aarab G., Lobbezoo F., Hamburger H.L., Naeije M. Oral Appliance Therapy versus Nasal Continuous Positive Airway Pressure in Obstructive Sleep Apnea: A Randomized, Placebo-Controlled Trial. Respiration. 2011 Apr; 81 (5): 411-9. DOI: https://doi.org/10.1159/000319595
Gagnier J.J., Kienle G., Altman D.G., Moher D., Sox H., Riley D., et al. The CARE guidelines: Consensus-based clinical case report guideline development. J Clin Epidemiol. 2014; 67 (1): 46-51. DOI: https://doi.org/10.1016/j.jclinepi.2013.08.003
Behrents R.G., Shelgikar A.V., Conley R.S., Flores-Mir C., Hans M., Levine M., et al. Obstructive sleep apnea and orthodontics: An American Association of Orthodontists White Paper. Am J Orthod Dentofac Orthop. 2019 Jul 1;156 (1): 13-28.e1. DOI: https://doi.org/10.1016/j.ajodo.2019.04.009
Gottlieb D.J., Punjabi N.M. Diagnosis and Management of Obstructive Sleep Apnea: A Review. JAMA - J Am Med Assoc. 2020 Apr 14; 323 (14): 1380-400. DOI: https://doi.org/10.1001/jama.2020.3514
Susarla S.M., Thomas R.J., Abramson Z.R., Kaban L.B. Biomechanics of the upper airway: Changing concepts in the pathogenesis of obstructive sleep apnea. Vol. 39, International Journal of Oral and Maxillofacial Surgery. 2010. p. 1149-59. DOI: https://doi.org/10.1016/j.ijom.2010.09.007
Awad M., Gouveia C., Zaghi S., Camacho M., Liu S.Y.C. Changing practice: Trends in skeletal surgery for obstructive sleep apnea. Vol. 47, Journal of Cranio-Maxillo-Facial Surgery. Churchill Livingstone; 2019. p. 1185-9. DOI: https://doi.org/10.1016/j.jcms.2018.11.005
Shelton K.E., Woodson H., Gay S., Suratt P.M. Pharyngeal fat in obstructive sleep apnea. Am Rev Respir Dis. 1993; 148 (2): 462-6. DOI: https://doi.org/10.1164/ajrccm/148.2.462
Eckert D.J., Malhotra A. Pathophysiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008; 5 (2): 144-53. DOI: https://doi.org/10.1513/pats.200707-114MG
Schendel S.A., Broujerdi J.A., Jacobson R.L. Three-dimensional upper-airway changes with maxillomandibular advancement for obstructive sleep apnea treatment. Am J Orthod Dentofac Orthop. 2014; 146 (3): 385-93. DOI: https://doi.org/10.1016/j.ajodo.2014.01.026
Giles T., Lasserson T., Smith B., White J., Wright J., Cates C. Continuous positive airways pressure treatment for obstructive sleep apnoea in adults (Review). Cochrane Database Syst Rev. 2008; (3): 1-113.
Ngiam J., Balasubramaniam R., Darendeliler M.A., Cheng A.T., Waters K., Sullivan C.E. Clinical guidelines for oral appliance therapy in the treatment of snoring and obstructive sleep apnoea. Vol. 58, Australian Dental Journal. 2013. p. 408-19. DOI: https://doi.org/10.1111/adj.12111
Ng J.H., Yow M. Oral Appliances in the Management of Obstructive Sleep Apnea. Vol. 14, Sleep Medicine Clinics. W.B. Saunders; 2019. p. 109-18. DOI: https://doi.org/10.1016/j.jsmc.2018.10.012
Furuhashi A., Yamada S., Shiomi T., Sasanabe R., Aoki Y., Yamada Y., et al. Effective three-dimensional evaluation analysis of upper airway form during oral appliance therapy in patients with obstructive sleep apnoea. J Oral Rehabil. 2013 Aug; 40 (8): 582-9. DOI: https://doi.org/10.1111/joor.12059
Phillips C.L., Grunstein R.R., Darendeliler M.A., Mihailidou A.S., Srinivasan V.K., Yee B.J., et al. Health Outcomes of Continuous Positive Airway Pressure versus Oral Appliance Treatment for Obstructive Sleep apnea: A Randomized Controlled Trial. Am J Respir Crit Care Med. 2013; 187 (8): 879-87. DOI: https://doi.org/10.1164/rccm.201212-2223OC
Okuno K., Sato K., Arisaka T., Hosohama K., Gotoh M., Taga H., et al. The effect of oral appliances that advanced the mandible forward and limited mouth opening in patients with obstructive sleep apnea: A systematic review and meta-analysis of randomised controlled trials. Vol. 41, Journal of Oral Rehabilitation. Blackwell Publishing Ltd; 2014. p. 542-54. DOI: https://doi.org/10.1111/joor.12162
Gaisl T., Haile S.R., Thiel S., Osswald M., Kohler M. Efficacy of pharmacotherapy for OSA in adults: A systematic review and network meta-analysis. Sleep Med Rev [Internet]. 2019; 46: 74-86. Available from: https://doi.org/10.1016/j.smrv.2019.04.009 DOI: https://doi.org/10.1016/j.smrv.2019.04.009
Wray C.M., Thaler E.R. Hypoglossal nerve stimulation for obstructive sleep apnea: A review of the literature. World J Otorhinolaryngol - Head Neck Surg [Internet]. 2016; 2 (4): 230-3. Available from: http://dx.doi.org/10.1016/j.wjorl.2016.11.005 DOI: https://doi.org/10.1016/j.wjorl.2016.11.005
Brevi B.C., Toma L., Pau M., Sesenna E. Counterclockwise rotation of the occlusal plane in the treatment of obstructive sleep apnea syndrome. J Oral Maxillofac Surg [Internet]. 2011; 69 (3): 917-23. Available from: http://dx.doi.org/10.1016/j.joms.2010.06.189 DOI: https://doi.org/10.1016/j.joms.2010.06.189
Patel P.K., Novia M.V. The Surgical Tools: The LeFort I, Bilateral Sagittal Split Osteotomy of the Mandible, and the Osseous Genioplasty. Clin Plast Surg. 2007; 34 (3): 447-75. DOI: https://doi.org/10.1016/j.cps.2007.05.012
Yamashsita Y., Iwai T., Honda K., Fujita K., Imai H., Takasu H., et al. Effectiveness of subspinal Le Fort I osteotomy in preventing postoperative nasal deformation. J Plast Reconstr Aesthetic Surg [Internet]. 2020; 73 (7): 1326-30. Available from: https://doi.org/10.1016/j.bjps.2020.02.014 DOI: https://doi.org/10.1016/j.bjps.2020.02.014
Kongsong W., Waite P.D., Sittitavornwong S., Schibler M., Alshahrani F. The correlation of maxillomandibular advancement and airway volume change in obstructive sleep apnea using cone beam computed tomography. Int J Oral Maxillofac Surg. 2021 Jul 1; 50 (7): 940-7. DOI: https://doi.org/10.1016/j.ijom.2020.11.017
Gil A.P.S., Machado-Fernández A., Guijarro-Martínez R., Hernández-Alfaro F., Haas O.L., de Oliveira R.B. Le Fort I osteotomy and soft tissue response: A retrospective cohort study comparing three different techniques. J Cranio-Maxillofacial Surg. 2022; 50 (2): 107-13. DOI: https://doi.org/10.1016/j.jcms.2021.11.009
Torres H.M., Valladares-Neto J., Torres É.M., Freitas R.Z., Garcia Silva M.A. Effect of Genioplasty on the Pharyngeal Airway Space Following Maxillomandibular Advancement Surgery. J Oral Maxillofac Surg. 2017; 75 (1): 189.e1-189.e12. DOI: https://doi.org/10.1016/j.joms.2016.09.005
Kuşçu O., Süslü A.E., Özer S., Günaydin R.Ö., Öʇretmenoʇlu O., Önerci M. Sole effect of genioglossus advancement on apnea hypopnea index of patients with obstructive sleep apnea. Acta Otolaryngol. 2015; 135 (8): 835-9. DOI: https://doi.org/10.3109/00016489.2015.1030770
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